The Pantry of Broward Volunteer Application

* Required.

*First Name:
*Last Name:
 Gender:
 Male Female
*Address:
*City:
*Zip:
*Email Address:
*Phone to reach you at anytime:
*Date of Birth:
*Emergency Contact Person:
*Name
 
*Phone:
 
*Relationship:
Marital Status:
 Single Married Domestic Partner Widowed Other
Ethnicity:
 African American Asian American Caucasian Hispanic Other
Primary Language:
 English Spanish   Other:    2nd:
Employment Status:
 FT PT Student Retired Not Emp.   Other:
If employed, name of employer:
Contact name for employer:
Contact phone for employer:
Duties and responsibilities:
Do you have any medical restrictions?:

Have you ever served in the U.S. military?:
 Yes No
If yes, end date:
Have you ever been convicted of a felony?:
 Yes No
Or a misdemeanor?:
 Yes No
If yes explain:
 

Volunteers will receive a T- shirt to wear. Please indicate size you will need:
 Small Medium Large X Large XX Large   Other:
 
Your position as a volunteer depends on your skills and abilities. Wherever your interests lay is where you would be most beneficial to the Pantry of Broward Inc. This may include getting your hands dirty, light to heavy lifting, performing other administrative tasks such as answering telephones or assisting staff with other responsibilities. The daily operations and support of our various projects would not be possible without you, the volunteer.
 
On behalf of The Pantry of Broward, Inc. we thank you for your help!
Please indicate how you heard about the opportunity to become
a volunteer for The Pantry of Broward:
 

How would you like to help “The Pantry of Broward”

 Pack Food Boxes Stock Food Shelves Sweep/Clean Food Drive Driver
 Receptionist Office Help Organize the Pantry Computer Help (Excel/Word)

We are also looking for:
1. Drivers to deliver food boxes to seniors
2. People to run Food Drives at their place of business
3. Historian
4. Please tell us your ideas if any:
 

If you are under the age of 18 please supply parent or guardian information:
Volunteers must be at least 16 years of age. If the signor is under the age of 18 this form must also be signed by a parent or guardian or legal representative
 
Parent or Guardian Full Name:
Relationship:
Phone:
Email Address:

I understand that my services are being offered on a voluntary basis without anticipation of financial compensation. I shall indemnify and hold harmless The Pantry of Broward, Inc., its Board of Directors and/or Commissions, and officers, agents and employees from and against all claims, demands, or loss of liability of any kind or nature for any possible injury incurred during volunteer services. (Application will not submit without accepting)

Check if you accept:

After filling out the above form
click submit to send your information to
The Pantry of Broward