Pre-Registration Form for Food Assistance (English)


If you would like to register to receive food from Feeding Hands Pantry, please complete all questions below (* are required). 

You must provide a phone number or email to get your appointment.

Who is the head of household that will pick up the food? *

First name
Last name
Date of birth (mm/dd/yy)

Household information: *

Total number of people in household
Number of adults age 60 or over
Number of children under 18

Household address: *

Street address
Zip code
If County = "Other", What County do you live in?your full name
Are you receiving any of the following governmental assistance?Check all that apply.
Was your family income reduced because of COVID-19? *
Are you having difficulty affording your housing or other basic needs? *

Contact information:

Either phone number or email is required to get your appointment.  If you do not have a phone, please provide the number of someone who can get messages to you.

Phone number *
Is this a cell phone number? *
Do you want to receive your client number and appointment time via email or text? *
Select a timeframe/location for your appointment: *
Conditions to Receive Assistance *As conditions for receiving assistance, I acknowledge, consent to, and certify the following: (Check all to acknowledge your agreement.)

Client Signature:  

By typing your full name, you acknowledge, consent, and certify to the above information.

By typing your full name, you acknowledge, consent, and certify all details.
Date (mm/dd/yy)

Next Steps:

  1. If you provided an email address, you will immediately receive an email confirmation from  Please check your Junk Email folder if you do not see the message in your Inbox.
  2. Within the next few days, you will receive a client number (required at your first appointment) and appointment day and time via email or text. You can receive food once a month by appointment.

Please bring the following to your appointments:

  • Client card (you will receive this on your first visit)
  • Photo ID
  • Proof of address (electric bill, phone bill, or other document with your name and physical address)