Emergency Food Pick Up Order from Active Faith for week of 3/30/20 **Produce choices will be updated Monday morning.
Pickup is Monday, Wednesday, or Thursday from 11:00 a.m. - 4:30 p.m.
Form must be submitted by 4:00 p.m. in order to be ready for pick up that day.
In the interest in maintaining social distancing, when you pull up to our building, please remain in your car and one of our volunteers will meet you there.
First and Last Name
Complete Address including zipcode
Number of Adults in the Household (18+)
Number of Children in the Household (under 18)
Are you a current Active Faith client? (For bookkeeping purposes only, does not affect eligibility to receive emergency food assistance)
When do you plan to pick up your order? (Please allow at least one hour for us to prepare your order) You are only able to receive food once/week.
Monday between 11:00 am - 1:00 pm
Monday between 1:00 pm - 3:00 pm
Monday between 3:00 pm - 4:30 pm
Wednesday between 11:00 am - 1:00 pm
Wednesday between 1:00 pm - 3:00 pm
Wednesday between 3:00 pm - 4:30 pm
Thursday between 11:00 am - 1:00 pm
Thursday between 1:00 pm - 3:00 pm
Thursday between 3:00 pm - 4:30 pm
Please list any food allergies/sensitivities or any other comments. (Food allergy considerations will be accommodated when possible, but the responsibility to check packaging is on the family receiving the food)
Produce (Check choices) if available
The following is a list of items we could possibly have in the food pantry. Please check the items that you are in need of today. We will do our very best to provide what you need if it is available.
Macaroni and Cheese
Canned Tomato Products (could include diced tomatoes or tomato sauce)
Ramen noodle Chicken flavor
Baking or Corn Muffin Mix
Boxed (Shelf Stable) Milk
Milk, if available (could be fresh or frozen)
Dry Split Peas
Peace Tea Pineapple Green Tea in a can
Protein drinks Vanilla Cappuccino
Oatmeal Granola Bars
Chocolate Chip Granola Bars
Canned Soup (Choose 2)
Cream of Chicken
Cream of Mushroom
Canned Vegetables (Choose 3)
Canned Beans (Choose 2)
Baked or Pork n' Beans
Canned Fruit (Choose 2)
Canned Meat (Choose 1)
Bread (Choose 1)
Cereal (Choose 1)
Juice (Choose 1)
Frozen Meat (Please choose 1)
Fully Cooked Chicken Breasts
Dark Meat Chicken Fajita Meat
Fully Cooked Pulled Pork
Fully Cooked Pork Taco Meat
Pork Loin Roast
Are you in need of personal hygiene products? Choose 1 item:
Dental Hygiene kits
Please read the following disclosure statement, by submitting this form you agree to the conditions listed. Please note regardless of income you are declaring that you are in need of emergency food,
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service