Survey - Volunteer Registration Form

Please provide your contact information:

*

Name:

Title	First Required	Last Required

*

Email: Required

*

Street 1: Required

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

*

Date of Birth: Required

Date of Birth:

Yes, I would like to receive e-mail from Cleveland Foodbank

Please enter a user name and password for logging in when you return. You can use this password to update your information or receive personalized content.

*	User Name: Required	5 to 60 characters
*	Password: Required	5 to 20 characters
*	Repeat Password: Required

Question - Not Required - Work Phone Number (including area code and extension):

Question - Not Required - Fax Number (including area code):

*

I am:

(Select one of the available choices or enter a different value.)
Question - Required -

Question - Not Required - If you are a student, where?

*

Question - Required - Have you ever been convicted of a felony? Unfortunately, you cannot volunteer if you are a convicted felon.

Question - Not Required - (Optional) Race or ethnic origin:

*

Question - Required - Age:

Question - Not Required - I am coming to the Foodbank with a group that is (check all that apply):

	No group
	Religious organization
	School
	Work
	Community group
	Other

Question - Not Required - My group's name is:

Question - Not Required - Community Service: School group
Court ordered

*

Question - Required - Volunteer Interests (check all that apply):
Please make between 1 and 4 selections from the choices below.

	Repackage food donations
	Meal preparation and kitchen assistance
	Sort and repackage produce
	Office projects

*

Question - Required - Days available to volunteer (check all that apply)

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday

*

Question - Required - Times available to volunteer (check all that apply):
Please make between 1 and 5 selections from the choices below.

	Mornings
	Afternoons
	Evenings
	Weekends
	Short Notice

Question - Not Required - Any physical restrictions or special needs?

Question - Not Required - Special skills or areas of interest?

In case of emergency, please contact:

*

Question - Required - Name:

*

Question - Required - Relationship:

*

Question - Required - Address:

*

Question - Required - City:

*

Question - Required - State:

*

Question - Required - Zip Code:

*

Question - Required - Phone Number: