Pre-Registration Form in English

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

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

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

Household Information: 

Household address:

County: Feeding Hands serves residents in these local areas.*

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

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.

Next Steps:

  1. If you provided an email address, you will immediately receive an email confirmation from hello@feedinghandspantry.org.  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)

Thanks for submitting!