Thank you for your interest in volunteering at the MaineHealth Food Pantry at MMC!
Please fill out all required fields.

What's your email address?

Your information

Required fields are marked with an asterisk (*).
First Name *
Last Name *
Mobile Phone *

For example, 123-456-7890
Alternate Phone
Alternate Email
What city/town do you live in? *
Date of Birth *

A valid date as MM/DD/YYYY (for example: 11/30/2015)
Emergency Contact (Full Name) *
Emergency Contact - Phone # *
Emergency Contact - Relationship *
Would you like to share your pronouns?

Are you a volunteer or a MaineHealth employee? *
Job Title (MaineHealth employees only)
Department (MaineHealth employees only)
Your Supervisor (MaineHealth employees only)
Are you volunteering for any of the following reasons?
If so, which organization, company, school, or agency?
How much weight can you lift safely? *
Are there any food/environmental/chemical allergies or existing injuries you would like to disclose?
What day(s) are you most consistently available? Please select all that apply. *

What times of day are you available? Please select all that apply. *

Are you fluent in another language other than English and are interested in using that skill at the pantry? *
If yes, please check all the languages that apply. We will follow up with a language proficiency test.

Other language(s)
Is there any other information you would like to provide? (Please include here if you need any accomodations ex: lactation room, prayer space, etc...)


MMC Food Pantry Volunteer Agreements:
As a volunteer at the MMC Food Pantry, I agree/understand:
• That my involvement with the MMC Food Pantry is voluntary and that I am participating at my own risk.
• That participation in volunteer activities involves certain risks. I am voluntarily participating in the volunteer activities with knowledge of the danger involved and I agree to accept all risks of participation.
• To take personal responsibility to accept only those assignments I am ready and capable of completing safely.
• To communicate any personal limitations and concerns to pantry staff.
• To work safely.
• To show respect for myself and others.
• To review and comply with MMC Food Pantry’s “Volunteer Expectations”

Liability Insurance:
• Maine Medical Center indemnifies and protects all of its employees and volunteers from any claim or liability arising from their negligent acts provided that they were on duty and acted in good faith at the time of the incident. They are also free to obtain their own liability insurance if they wish.

I hereby give my permission for MMC Food Pantry to use my photograph/likeness/image/ recording in its various publications, promotions, and other media.

MMC Food Pantry Confidentiality and Non-Disclosure Agreement:
All volunteers have a responsibility to program participants, other volunteers, and the community that personal information will remain confidential. As a volunteer, you can expect this same respect for privacy. We are happy to talk with you further if you have any questions. Please see MMC Food Pantry staff member or contact us at

Though not all-inclusive, the following provides some guidelines concerning the matter of confidentiality:

1. No identifying information about MMC Food Pantry volunteers or program participants (names, addresses, social security numbers, physical disabilities etc.) is revealed to anyone outside of MMC Food Pantry.

2. Discussing personal circumstances without permission of the individual, even without names, addresses, is also a breach of confidentiality.

That is, a volunteer might describe personal circumstances and information, and even though the name and address are not revealed, this descriptive material may jeopardize the individual’s right to privacy. Thus, the discussion or description of personal information or circumstances is detrimental to maintaining confidentiality.

3. The fact that a case is public through the news media does not alter the fact that the individual still has confidentiality privileges within MMC Food Pantry’s programs. Thus, in this these situations, confidentiality should still be maintained.

All volunteers must sign the following oath to respect the confidentiality of all individuals for whom they come in contact through their volunteer service with MMC Food Pantry.

Non-Intake Personnel Civil Rights Training:
We are required by the U.S. Department of Agriculture (USDA) to ensure that all clients are informed and aware of their civil rights while they are being served. You are our eyes and ears and can help us identify any instances in which a client is subject to harassment or discrimination. The State of Maine will not tolerate harassment or discrimination by any individual.

What is discrimination? Discrimination is the practice of unfairly treating a person or group of people differently from other people or groups of people. The USDA prohibits discrimination based on Race, Sex (including orientation and gender), Color, Disability, National Origin, Age, or Reprisal or retaliation for prior civil rights activity.

Here is an excerpt from the Civil Rights Act of 1964 (it’s been amended to protect additional groups referenced above). “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity of an applicant or recipient receiving Federal financial assistance from the Department of Agriculture or any Agency thereof.”

Before you volunteer today or interact with food assistance program participants, you must agree to comply with the above statements. To show your agreement and acknowledge your understanding to not discriminate, please check the box and provide your name below. This institution is an equal opportunity provider.