Lifeboat Food Pantry - New client registration form

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Lifeboat Food Pantry - New client registration form - every Thursday 4-6 pm

Every Thursday from 4:00 - 6:00 pm

105 Jersey Street, Boston, MA 02215
Contact us at (617) 383-9864, LifeboatBoston@gmail.com or visit our website www.lifeboatboston.org or our Facebook page- facebook.com/lifeboatboston/

Please take a moment to answer all questions so that we may serve you better. For funding and reporting purposes we collect the following information from our clients. We will serve anyone in need regardless of ethnicity, race, color, sexual orientation, national origin, gender, age, disability, religious or political beliefs. This information is confidential and will not have a negative effect on services provided to you.

** Please indicate if you are someone in your household is COVID-19 positive or has recently been in contact with someone that is COVID positive. *

Yes

First and Last Name *

Address *

Phone number *

How did you hear about Lifeboat?

Employment status

Employed

Unemployed

Retired

Disabled

Student

Other:

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Estimated total monthly income

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