NCS Food Program Participant Registration

Name *

First Name Last Name

Address *

Street Address

City State

Zip Code

Phone Number *

Area Code Phone Number

Email

Gender

Marital Status

Number of adults *

Age of Adults

18-30 30-64 65+

Number of children under the age of 18 *

Age of Children

Infant Toddler to 4yrs 5yrs to 12yrs 13yrs to 18yrs

Income Level

Have You been Impacted By Covid *

Yes Yes, lost loved One No

We've implemented Social Distancing guidelines to keep everyone safe.

PLEASE READ THE FOLLOWING RULES.

When you arrive:

You agree to verify information submitted online by showing ID
You agree to present I.D. used for registering.
You agree to remain in your car. One of our volunteers will bring the food out to your car and place in the trunk for you.
You agree there will be no loitering, standing around and/or large gatherings.
You agree to exit the facility parking area safely and promptly once you've received your food.
No one is allowed to enter the building where the food is stored.
There are no public restrooms.

Thank you for your cooperation.

Please Let Us Know if You are Interested in Other Services

Mental Health/Counseling Services Safe Exchange Services for Child Custody Visitation/Parenting Time

Food Registration