Mitzvah Food Program Volunteer Registration Form

What type of volunteer are you? Check all that apply: *

Date of Bar or Bat Mitzvah *

Synagogue Name *

Number of volunteer hours you need to complete with us *

Preferred date of completion of your volunteer project *

Phone Number *

Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Date of Birth (MM/DD/YYYY) *

Please list: Name, Relationship and Date of Birth of each additional volunteer

Name of Volunteer Group or Family *

Contact Person/Group Leader (usually the same person whose information has been filled in in the Basic Information section of this form) *

Estimated number of volunteers or family members in your group *

Please list: Name, Relationship and Date of Birth of each additional volunteer

Provide the pantry site to which you will be delivering the collected food *

Date of Delivery *

Approximate Time of Delivery * :

If this is a Holiday Food Drive, please check which type

If this is a targeted food drive, please list the targeted food item or items here: (i.e. soup, tuna)

Would you like us to email you a food drive flyer or preferred list of food items?

Yes

If you have any questions, comments, requests or if there is any other information that you would like us to provide to you, please write it here