Food Pantry Application

HARDIN BAPTIST CHURCH FOOD PANTRY APPLICATION

We reserve the right to ask for identification when food order is picked up. FOOD PANTRY RULES: All food orders must be turned in by TUESDAY AT 3:30PM in order for food to be ready by WEDNESDAY. Food

orders will be ready for pick up on Wednesdays between

4:30 – 5:30 p.m. Date: ______________Name: ______________________________________________ Address: ________________________________________________________________ Phone #: _______________________________________________________________ Home Church: ____________________ Pastor’s Name___________________________ Marital Status (please circle): Married

Single

Divorced

Widowed

Separated

Place of Employment: _______________________________________________

If anyone else in your household works, please list their place of employment:

_________________________________________________________________ So that we may package foods better to serve your family’s needs, please list the names of all persons living at the above address:

Name: __________________________________________ Age: __________________ Name: __________________________________________ Age: __________________ Name: __________________________________________ Age: __________________ Name: __________________________________________ Age: __________________ Name: __________________________________________ Age: __________________

If you have an allergy, or do not like some vegetable, fruit, meat, etc., please write this out to the side of that category, so we can better serve you. *WE MAY NOT HAVE ALL ITEMS AVAILABLE EACH WEEK.*

FOOD ITEMS ____ Peanut Butter ____ Jelly ____ Saltine Crackers

THE FOLLOWING ITEMS WILL BE GIVEN ONCE A MONTH ____ Soap ____ Shampoo ____ Dish Soap

____ Animal Crackers

____ Toilet Paper

____ Canned Vegetables

____ Laundry Detergent

____ Canned Fruit

____ Feminine Care Products

____ Canned Meat ____ Chicken Noodle Soup

THE FOLLOWING ITEMS WILL BE GIVEN ONCE EVERY 2-3 MONTHS (this will depend

____ Vegetable Soup

on the age and number of family members)

____ Instant Potatoes ____ Ramen Noodles ____ Spaghetti Noodles & Sauce ____ Macaroni & Cheese ____ Cereal ____ Oatmeal

____ Toothpaste & Toothbrush ____ Deodorant ____ Sugar ____ Salt ____ Pepper ____ Mayonnaise ____ Mustard ____ Cooking Oil ____ Ketchup

If you have received food from Samaritan’s Pantry before, have you attended one of our church services? Yes ____ No ____