Brixworth Community Larder

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Registration Form

Brixworth Community Larder

First Name *

Surname *

Please provide us with your address *

Please provide us with an email address if you have one

Employment Status *

Employed

Self-Employed

Unemployed

Collecting Benefits

Retired

I'd rather not say

Number of adults in household *

Number of children and ages *

Food allergies or intolerances *

Local Larder preference *

Brixworth

Other

How did you hear about the community larder?

How will being a member of the community larder help you?

Make money go further

Save food from waste

Access to food

Meet new people

Clear selection

Do you agree to look after the food well and to store it appropriately? Do you agree that the food is NOT for resale under any circumstance? Do you understand your membership will be cancelled if you contravene the Larder T&Cs? *

Yes

Do you agree to your personal information being held by the Northamptonshire Community Larders for the purposes of providing their services? *

Yes

Would you like to receive updated information / newsletters from your local Larder? *

Yes

Preferred method of contact *

Telephone

Mail

The below questions are optional. By answering them, you help us learn more about our members, to enable us to improve our services.

Age Group

18 - 25

26 - 40

41 - 55

56 - 70

71 - 85

86 +

Clear selection

Ethnicity

Do you have a physical or mental health condition, or life-limiting illness?

Are you a carer?

Yes

Clear selection

Full T&Cs are available on the website, and can be provided as a hard copy if requested.

Submit

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