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Please provide the following information if you would like to receive weekend food bags for your children. Include only children aged 1-17 years old. If you have more than six children, include that information with the last entry. Information will be kept completely private and is only being collected to ensure we have enough food available each week. This program runs on donations (and volunteers) and in order to keep it running we must keep accurate data of who we are serving. Email addresses will be used to keep families up to date on any changes to distributions. We will be sending out an email to let families who have signed up know when the program will be starting. Because this program will require sign-ups, we will not be posting as much information publicly on Facebook about the events like we did during the summer. You only need to sign up once to continue receiving food weekly. Please do not sign up if you can not commit to picking food up each week at the designated time. You may remove your name from the list at any time by emailing us. Sign-ups must be received by the Friday prior to the next food distribution in order to receive food for that week. Sign-ups received between Mon-Thurs will be eligible for pick up in the following week's food distribution, not in the week that the sign-up occurred. To avoid confusion, once we receive your sign-up, we will email you to let you know when you can begin picking up food. If you come to get food prior to hearing from us or prior to the designated date, you will not receive food. If you can not make it to a pick-up for any reason, please email us to let us know ASAP. Someone else may pick up your bags for you. No pick-ups will be available outside of the designated time. Missed pick-ups (without letting us know) will result in removal from the list so that the food is available for others who need it. No make-up bags will be available for missed pick-ups. Sign-ups do not guarantee availability of food bags. It is possible we will have to place families on a wait list or close sign-ups completely if our supplies do not match the demand. Please note, we do have a box outside our door with food available at any time, for anyone who needs it. It's filled as donations are received. *Terms may be updated or changed at anytime without notice. In an effort to reduce waste, we'd like to distribute food in reusable bags to be returned each week. If you have any laying around that you don't use, please consider donating them.
Email address *
By filling out this form, I understand that Feeding Northern Arizona's Future (FNAZF) and Camp Verde Family Chiropractic (CVFC) are not responsible for any allergic reactions or other issues that may or may not be caused by the food provided. I understand that I am responsible for ensuring that the food provided is something my child/children can consume. I understand that FNAZF and CVFC do their best to ensure all food is in-date and not tampered with and otherwise is safe to consume, but understand that I am primarily responsible for ensuring anything given to my family is safe to consume and FNAZF and CVFC will not be held liable for any issues related to the food provided. *
I can commit to picking up food on Thursdays at 5:30pm. *
Parent/Guardian name *
Your answer
How many total people in your immediate family that live in your household? *
Your answer
Child's first name and age *
Your answer
Child's first name and age
Your answer
Child's first name and age
Your answer
Child's first name and age
Your answer
Child's first name and age
Your answer
Child's first name and age
Your answer
A copy of your responses will be emailed to the address you provided.
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