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.
Email address *
First and Last Name *
Your answer
Complete Address including zipcode *
Your answer
Number of Adults in the Household (18+) *
Your answer
Number of Children in the Household (under 18) *
Your answer
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. *
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)
Your answer
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. *
Canned Soup (Choose 2)
Canned Vegetables (Choose 3)
Canned Beans (Choose 2)
Canned Fruit (Choose 2)
Canned Meat (Choose 1)
Bread (Choose 1)
Cereal (Choose 1)
Juice (Choose 1)
Frozen Meat (Please choose 1)
Are you in need of personal hygiene products? Choose 1 item:
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,
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