Food Pantry Volunteer Form

Today's Date *

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Preferred Phone *

Alternate Phone

Email *

Do you have any special skills?

Are you a Middle School or High School student? *

Yes
No

Do you need to fulfill court-mandated community service hours?

Yes
No

If yes, explain:

Frequency of Volunteering: *

Weekly
Biweekly
Monthly
On-Call

Day(s) Available:

NOTE: See page 2 for preferred jobs checklist

Hours Available

Comments:

Capable of lifting 30lbs?

yes
No

Capable of lifting 50lbs?

Yes
No

Volunteer Contract: I pledge to carry out my duties as a volunteer at the Burlington Food Pantry in a trustworthy and diligent manner and to be courteous and helpful to all clients, guests, customers, staff, and other volunteers. I agree to follow all policies of the Burlington Food Pantry. *

Yes

Food Pantry Volunteer Form

Please fill out the two-part form below: