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New Family Pantry Registration

Registration For Food Pantry Services

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* 1. Have you received food from our food pantry in the past 4 months?
IF SO, you may exit this survey. Please do not complete this registration. You are already registered. We have received many  registrations from our current pantry families and it is not necessary.

IF NOT, please continue and complete this registration so that you can use our services.

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* 2. Please provide the following information.

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* 3. We currently only service families living in the Red Lion, Dallastown, or Eastern School Districts. You must live in one of those school districts to register to use our pantry.  
What school district do you live in?

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* 4. How many people live in your household?

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* 5. Does anyone in your household have any allergies? If so, please provide details.

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* 6. You must provide the following information  for each household member
Household Member 1- Yourself

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* 7. You must provide the following information for each household member
Household Member 2

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* 8. You must provide the following information for each household member
Household Member 3

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* 9. You must provide the following information for each household member
Household Member 4

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* 10. You must provide the following information for each household member
Household Member 5

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* 11. You must provide the following information for each household member
Household Member 6

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* 12. You must provide the following information for each household member
Household Member 7

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* 13. You must provide the following information for each household member
Household Member 8

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* 14. Are you or anyone else in your household currently employed?

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* 15. Do you or anyone else in your household receive SNAP benefits? (your registration will not be effected whether or not you receive SNAP benefits)

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* 16. Are you currently homeless or live in temporary housing? If so, please contact us directly at 717-244-6934 to receive an emergency food box and to let us know if you have restrictions on what type of food you can receive based on whether or not you have access to a refrigerator and stove. 

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* 17. After completing this registration, please visit  the Pantry Services page on our website to schedule your food pick up. Please schedule your food pick up at least 2 business days from today.

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* 18. If you need to change or cancel your appointment, you can cancel or change your appointment up to 12 hours prior to your appointment time using the same link that you used to schedule your appointment. If it is under 12 hours please call us directly. 
We do ask that you cancel  at least 24 hours prior to your scheduled appointment time.  

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* 19. Would you like to a proxy that can pick up your monthly food box if you are not able to? If so, please list their name and phone number.

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* 20. You allowed to pick up food once a month. If there is an emergency situation and you need extra food, please contact us directly.

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