Dear Friend of The Charity Guild
With home delivery assistance provided by Resilient Roses Respite, The Charity Guild Food Pantry would like to provide you with food assistance this week. This is a temporary assistance program that we are offering during the current COVID-19 health crisis. By completing and signing this release form you are granting permission to Resilient Roses Respite to pick up food from The Charity Guild food pantry on your behalf and deliver this food directly to you. You also grant Resilient Roses Respite the permission to share this information as well as a photo of your photo ID and a current piece of mail with you name on it with The Charity Guild on your behalf. The Charity Guild may follow up with you after your delivery. This is a free food assistance program. The Charity Guild, Inc. Food Pantry Permission Form - The Charity Guild, Inc, is a 501(c)(3) non profit organization. We are a member agency of The Greater Boston Food Bank.
Entering your name as text on this form will serve as an electronic signature that grants the permissions as outlined on this form.
NAME (First & Last)
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Email address
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What is your date of birth (D.O.B.)?
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Month
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Day
Year
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What is your ethnicity?
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Are you currently employed?
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Yes
No
Other
PHONE NUMBER
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ADDRESS: ( please include house number, street, city, state and zip code)
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Please submit a copy of your I.D. and proof of address (i.e. current mail, utility bill, etc.) For children in the household, please submit a birth certificate and/or report card for proof of identity and address.
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*This is information that we are asked to report when applying for grants to support our mission. We do not share your personal information. We do not share your name, address, phone or email. Contact Info: Laura Striese - Executive Director, The Charity Guild - Email: Laura@thecharityguild.org / 508.583.5280
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