Food Bank Order Form

Food Bank Order Form

Everyone accessing the Harvest Food bank MUST BE REGISTERED. You can now register online, but will still need to bring in a piece of ID to complete your registration. You can find the registration form on the Island Community Services website. Please have your orders in by Monday night at the latest!! Please note that orders submitted online will be ready for pick-up on Tuesday during Food Bank hours - between 10:30am. and 3:30pm. *PLEASE BRING BACK YOUR RE-USE BAGS SO WE CAN FILL THEM UP AGAIN!*
Personal Information
Name*

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I will be picking up*

YesNoGroup Delivery - if registered & approved
Group Delivery Location Code*
YOU MUST BE APPROVED & REGISTERED FOR GROUP DELIVERY
Pick-up person's name*
If other than yourself
Number of Adults in this food order(18+)*
Number of Children in this food order
Leave Blank if none
Ages of Children*

Between 0-5yrsBetween 6-12yrsBetween 13-17yrs
Household Members
Do you Have access to cooking facilities?*

YesNo
Do you have any dietary preferences?

MeatVegetarianVeganOther
Do you have any allergies we should know about?
Leave blank if none
CANNED GOODS

SELECT ALL ITEMS YOU ARE WILLING TO RECEIVE. Please note that all items are subject to availability and a selection will be made based on your household size.
Soup
Protein

Canned TunaPeanut ButterBaked BeansChickpeasRed Kidney BeansBlack Beans
Canned Vegetables

Sweet CornGreen Beans
Other Canned Goods

Pasta Sauce (vegetarian)Chili (meat)
Fresh Produce
Fruits

BananasNew Season ApplesLocal PearsGrapes
Vegetables

OnionsPotatoesCarrotsFarm Fresh Produce
Dairy and Alternatives
Beverages

Apple Juice
Protein

EggsTofu
Protein
Dairy

MargarineBread/Buns
Dry Goods
Dry Goods

White SugarFrench Vanilla CoffeeBlack TeaFlourOats or Quick OatsDried Chickpeas or LentilsWhite RicePasta
Extras

Please select 2 extra items (per person) and a selection will be made based on availability and household size.
Food Extras

BBQ ChipsMystery CondimentsGoldfish Crackers - Jalapeno CheeseQuick NoodlesPopcornMexican Fixins'
Personal Hygiene/Household
Baby Supplies

Baby FoodDiapers (please specify size in comments, newborn to size 6)
Pet Supplies

Cat FoodDog Food
Anything else you would like to tell us?
All the items listed above are subject to availability and quantities will reflect household size. Not everything selected may be included in the order. In order to receive food hampers from the food bank, recipients need to register. This quick process can be done on your first visit. Please bring a piece of ID if you have not yet registered.*

I understand
Should be Empty:

Food Bank Order Form

CANNED GOODS

Fresh Produce

Dairy and Alternatives

Dry Goods

Extras