• Registration

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  • HOUSEHOLD INFORMATION

    Please list how many people live in the household

    *Including head of household

  • Privacy Policy Summary

    1. Reading this Summary document is not a substitute for reading the PantryTrak Privacy Policy in full.

    2. Food banks, food pantries, and other service providers that use the PantryTrak System, have agreed to the terms of a Master Subscription Services Agreement that includes adherence to this Privacy Policy.

    3. The Privacy Policy acknowledges that Personal Data is being collected in conjunction with your request for service.

    4. Personal Data may include, but is not limited to: (a) first and last name, (b) home address, (c) date of birth and/or age (d) email address, (e) mobile and/or home phone number, (f) income information, (g) employment information, and (h) family, household, and/or dependent information.

    5. Personal Data will not be sold for direct marketing purposes.

    6. The Privacy Policy may change at any time; the most current version can be found at www.pantrytrak.com/privacy

  • I certify that the information and income listed is true and correct, that I received food assistance, and that no other member of my household has applied for and received food during this distribution.  I understand that misrepresentation of need, or sale, or exchange of food is prohibited.

  • Clear
  • This program is available to all eligible recipients regardless of race, color, national origin, age, sex, sexual orientation, or handicap.

  • Should be Empty: