Lifeboat Food Pantry - New client registration form
Every Thursday from 3 - 5:00 pm

105 Jersey Street, Boston, MA 02215
Contact us at (617) 383-9864, LifeboatBoston@gmail.com or visit 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; however, 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.
First and Last Name *
Address *
Phone number *
What is your preferred appointment time? (we will try our best to accommodate your request) *
Required
Email
How did you hear about Lifeboat?
Employment status
Clear selection
Estimated total monthly income
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy