Food Pantry - Registration Form
We are offering a new Food Pantry service, You can collect a food parcel for £5. Deliveries are available for Elderly or disabled on High Rate Mobility for £9,  (eligibility criteria must be met before we can arrange a delivery).  This project reduces the food waste mountain and helps to ensure that people have access to discounted food on a regular basis? Every Friday between 10:30am  and 2:30 pm



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Please indicate if you require collection or delivery (please note we only deliver  in the LE4 - Beaumont  and Abbey Wards Only) *
Firstname *
Surname / Family Name *
Email Address  (This must be correct in case we have to contact you) *
Full Address *
Postcode *
Date of Birth *
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DD
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Gender *
Phone / Mobile Number - (This must be correct in case we have to contact you) *
Do you want to receive a email if and when we have an extra's 

 *
Do you have any dietary requirements? Please state below:
Your Ethnicity *
Do you live in a flat or house or Caravan? *
Please agree below: This service agreement between E2 and you is ongoing until either party gives 1 week's notice of termination, either verbally, in writing or any other method. Payment for the service is Cash Only and payable on collection/delivery. If either party requires a pause in the service they must provide at least 1 week's notice. No credit will be provided and the service is only provided on receipt of payment. Advance payments for the service can be accepted.                                                                       *
Nmber of Children in your family *
If you have children aged between 5-16 yrs on free school meals, do you consent for us to hold your information on file and contact you in regards to free activities and food during the holiday periods? If so please enter their Full Names, Ages and Genders. *
Beaumont Lodge Neighbourhood Association  has resumed their normal community activities: such as coffee mornings, Canasta, Computer clases etc,  would you be OK for E2 to contact you if they have a service they feel would suit your needs? *
Interests if any
I agree to my personal information being held by E2. Any personal information that you provide will be processed in accordance with the Data Protection Act 1998. It will be used by us and our delivery partners to deliver and improve services and fulfil our statutory and charitable duties.  We will not share your data with any other third-party without your express consent. *
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