By providing consent, you are agreeing that you understand that your responses will be collected, stored securely, and any data trends will be reported on and shared with relevant organizations for the purpose of improving SEND provision and wider community/ family support across Peterborough. If requesting vouchers your contact details will be shared with Foodbank and Peterborough City Council. If you wish to find out more, and be kept informed/ involved please office@familyvoice.org *
Required
Name (First and Last) *
Your answer
Address (Including postcode) *
Your answer
Contact phone number *
Your answer
Do you require a fareshare food parcel *
Do you require a foodbank voucher? (please note we can only issue three vouchers within six months of you first applying) *
How many adults are there in your household (anyone aged 18 or over) *
Choose
1
2
3
4
5
6
7
8
9
10
Over 10
How many children are there in your household (anyone 17 or under) *
Choose
0
1
2
3
4
5
6
7
8
9
10
Over 10
How many children/ young people in your household with special educational needs and disabilities (0-25) *
Choose
0
1
2
3
4
5
6
7
8
9
10
Over 10
If you have stated that you have children/ young people with SEND please provide their ages, gender and needs. If you do not have any with SEND please put N/A *
Your answer
Are there any adults in your household (including yourself) who have a disability, health problem. Please provide further details. If no-one has a disability/ health problem please put N/A *
Your answer
Please can you provide some details as to why you require support with food at this time. *
Your answer
Please provide any further details which you feel may be relevant.
Your answer
Do you have any dietary requirements *
Please note we are unable to cater for allergies, as we are unable to be sure that any food items have not come in to contact with any known allergens in the food handling process.
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