Please Register If you Plan to Pick up From the Supplemental Mobile Pantry on Monday June 1st AND/OR June 22nd 9am - 11:00am or 5:30pm - 6:30pm at CNE MIDDLE SCHOOL
This is SEPARATE & in ADDITION to the breakfast / lunch distribution the school district is doing. You must register each week. This distribution is for families, elderly & residents in the Clermont Northeastern area. Please fill out ONE per family. If you are filling out for an elderly neighbor/relative please ensure you fill out a separate form for them. This will be DRIVE-UP style. Stay in your car & we will bring it to you.
FIRST NAME *
Your answer
LAST NAME *
Your answer
If someone is picking up on your behalf, please enter his/her name here
Your answer
Full Mailing Address *
Your answer
Elderly *
Number of Adults in Household *
Number of Children in Household *
School Children Attend *
PICKUP OPTIONS, If you are picking up both dates, please check the date/time for both. You do not have to sign-up again later for these dates *
If you are homebound due to medical issues or elderly (high risk) and do not have someone who can pick up for you, please ensure your email or phone # is entered in the next step. This is will be a drive-up style pickup, no getting out of your car, volunteers will bring out to your car.
Required
Phone # *
Your answer
Email *
Your answer
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