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 Tuesdays 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
Food Bank Order

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.
Canned Goods
Protein

Peanut Butter
Canned Fish (Choose one - Depending on availability a substitution may be made.)

Canned Tuna
Canned Beans

ChickpeasRed Kidney BeansBlack BeansBaked Beans (vegetarian)
Canned Vegetables

Sweet CornGreen Beans
Other Canned Goods

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

BananasApples
Vegetables

OnionsPotatoesCarrotsGarlic
Dairy and Alternatives
Protein

EggsTofu
Dairy

Margarine
Bread and Alternatives

Please choose one, depending on availability a substitution may be made.
Bread/BunsBagels
Dry Goods

Please choose one in each category, depending on availability a substitution may be made.
Pasta

Pasta
Dried Beans/Legumes

Dried Chickpeas or Lentils
Rice

White Rice
Oats

Rolled Oats or Quick Oats
Flour

All Purpose Flour
Sugar

White Sugar
Beverages

Black TeaDecaf Black TeaCoffeeYerba Mate
Extras

Please select any extra items you would like to receive. There is a limit of 2 extra items per person and a selection will be made based on availability and household size.
Extras

Salad DressingMystery SoupInstant NoodlesKids SnacksSweet TreatsMystery CondimentSpicy ChipsFrostingMystery Snack (Wheat Snacks, Pretzels, Cheesies, Popcorn, etc)
Personal Hygiene/Household
Household

Razor
Sanitary Pads

Sanitary Pads RegularSanitary Pads Maxi
Tampons

Tampons RegularTampons Super
Incontinence Underwear or Adult Diapers

Depends size smallDepends size large
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

Food Bank Order

Canned Goods

Fresh Produce

Dairy and Alternatives

Bread and Alternatives

Dry Goods

Extras

Personal Hygiene/Household

Baby Supplies

Pet Supplies