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Northside Food Pantry Sign-Up Form
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Your Name:
Child(ren) Name(s):
(Must be a student at Northside Elementary)
Address:
City
State:
Email Address:
Current Phone Number:
(Main point of contact)
Number of Household Members: 
The undersigned client certifies that the information/answers provided are complete and true and further agrees to the following:
1. I understand that it is my decision to accept food from the pantry. I relinquish the Northside K-5 "Food Pantry" from all liability and accept the food at my own risk. (i.e. Northside will not be responsible for illnesses caused by food allergies)


2. Any inappropriate behavior on campus, including the use of profanity, verbal abuse toward staff, or disruptive conduct, is strictly prohibited. Such actions may result in the suspension or termination of your access to the food pantry.
By leaving your initials below, you're agreeing that this information is accurate and completed to the best of your ability. 
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