Volunteer Check-In Form

Volunteer Registration Form

On behalf of the Community Foundation of Northwest Mississippi, Molina Healthcare, the Northwest HUB, and Extra Table — thank you for choosing to be a HUNGER HERO at our EXTRA FEED Food Packing Event!
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Are you over 16?*

YesNo
Food Packing Event – Fighting Food Insecurity in Northwest Mississippi

Thank you for signing up to volunteer!
Together, we will pack 60,000 meals over two days to support families across our region.

Event Locations and Dates:
📍 Clarksdale: May 15, 2025 — 1536 US-49, Clarksdale, MS
📍 Hernando: May 16, 2025 — Gale Center, 2601 Elm Street, Hernando, MS

Volunteer Opportunities:
✅ Full Day (best way to help!)
✅ Morning Shift
✅ Mid-Morning Shift
✅ Afternoon Shift & Load-Out

Session 1: FULL-Day (best way to help!)

8:30–9:00 AM — Check-in

9:00–10:00 AM — Packing Session 1

10:00–10:30 AM — Break / Replenish Supplies

10:30–11:30 AM — Packing Session 2

11:30–12:30 PM — Lunch (provided)

12:30–1:00 PM — Check-in / Replenish Supplies

1:00–2:00 PM — Packing Session 3

2:00–2:30 PM — Break-down

Session 2: Morning Shift

8:30–9:00 AM — Check-in and Set-up

9:00–10:00 AM — Packing Session 1

Session 3: Mid-Morning Shift

10:00–10:30 AM — Check-in and Replenish Supplies

10:30–11:30 AM — Packing Session 2

Session 4: Afternoon Shift & Load-Out

12:30–1:00 PM — Check-in and Replenish Supplies

1:00–2:00 PM — Packing Session 3

2:00–3:00 PM — Loading Meals for Pantries & Break-down
Which Volunteer Session are you choosing to attend?*

Session 1: FULL-DaySession 2: MorningSession 3: Mid-MorningSession 4: Afternoon Shift & Load-Out
Which packing location are you wanting to attend?*

Clarksdale - May 15th at 1536 US-49Hernando - May 16th at the Gale Center: 2601 Elm StreetI will be working at BOTH event locations
Are you registering as a group or individual volunteer ?*

GroupIndividual
If you are registering as a GROUP VOLUNTEER, please identify the group/organization you are affiliated with?*
Are you registering as a volunteer representing a specific Food Pantry for this event?*

YesNo
If YES, what Food Pantry are you affiliated with?*
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to Volunteer*
I acknowledge and agree that the Community Foundation of Northwest Mississippi (CFNM) and its partners shall not be held liable for any personal injury or property damage that may occur in connection with my participation in volunteer activities, regardless of whether such incidents are due to their ordinary negligence or other causes. I further agree to indemnify and hold harmless CFNM and its partners from any and all claims that may arise from my involvement in these activities. Additionally, I grant permission for CFNM and its partners (listed below) to use my image, in both photographic and video formats, for promotional and informational purposes.
Signature of Volunteer*

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Volunteer Registration Form