Free Pantry Food Box - Application Form
COVID-19 is affecting all of us in different ways, but some more than others. The Globe Foundation with help from the Uttoxeter COVID-19 Support Group, are offering free food boxes full of long life products to help keep you going in times of need.

CRITERIA
The food boxes are available to residents in Uttoxeter, surrounding villages, up to Mayfield. One application per household. The boxes are for those that:-
- Are financially struggling and isolating due to COVID 19
OR
- Are a frontline NHS worker

CONTENTS
In the boxes you will be provided a mix of the following items, due to the nature of what we are doing, we cannot make any changes or substitutes to the boxes, but can provide boxes based on certain dietary requirements i.e. Gluten Free.
Typically included in a box is:
- Tinned tomatoes
- Pasta
- Pasta Sauce
- Couscous
- Bouillon
- Rice
- Cereals
- Bread or Bread mix
- UHT Milk (or milk alternative)
- Flour
- Baked Beans
- Oil

TO APPLY
Complete the form below or for help completing the form, please call the Uttoxeter COVID helpline on 07938952935. Please allow 3 days for your box to be delivered by a volunteer - this a 'no contact' service.
ELIGIBILITY
The food boxes are available to those that:-
- Are financially struggling and/or are in a isolating due to COVID 19
- Are a frontline NHS worker
I can confirm I am ... *
YOUR DETAILS
We will not pass your details to any third parties and will be used solely for the applicable food parcel service.
Name *
Age bracket
Clear selection
Address (with Post Code) *
Contact phone number *
Contact email address
How many people in your household? *
Dietary requirements *
Whilst we cannot guarantee that the boxes will not contain certain items, we will do our best to adhere to your dietary needs and will provide suitable alternatives
Required
How will this Free food box help you (and your family if applicable)? *
Additional notes
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