Rose Francis Foundation New Client Intake Form

If your family will be using the Emergency Financial Assistance program please complete our request form on our website. If your family will be using the Online Behavior Training program please locate training available for purchase or sliding scale on our websites online store. If your family will be using the Community Resource program please contact admin@rosefrancisfoundation.org with your specific needs to be sent a community resource list within three business days.

Thank you for enrolling in the Rose Francis Foundation Food Pantry. We are excited to support you and your loved ones with easier access to food in Fayetteville, North Carolina. The Food Pantry is 100% donation-based and funded by local donors and grantors around the United States. We are grateful to be able to bring this amazing program to you and your family.

You will receive a text/call from 910-203-1595 a week before you are eligible or pick up. Once you receive that message you will be able to schedule your pick up on our website by following this link; https://www.rosefrancisfoundation.org/book-online. Once you book your pick up date and time, you will only receive our food on that pick up date and time. Following your pick up you will be asked to complete a feedback form on your experience at this link; https://docs.google.com/forms/d/e/1FAIpQLSe17u3OWVpXwcg1FRBS5dPRZSbKpSKZ1Ot87JzlQXkeGeYvMQ/viewform?usp=sf_link 

To become a Client you will be required to complete all fields in this form, which includes; New Client Intake, Food Pantry Preferences, and media Release.

Due to the donation-based nature of our Food Pantry each member in your family is allotted 4 items from each category a month per person. You are not limited to the amount of times your request picks up or delivers throughout the month, just how many items you are allotted throughout the month. Additionally, as our donation volume increases items per person will increase as well. Our categories include; Perishable, Nonperishable, Clothing, Hygiene, and Miscellaneous.

Welcome to Rose Francis Foundation's Pantry Preference Form. Please complete the entire form to claim your preferences. Note: All preferences will guide Food Pantry volunteers and employees in selecting your monthly order. This form is not a promise that all preferences will be met. In the event you receive an item that you do not prefer contact(803)470-4012 for a exchange.

Required to complete by all recipients of services. At Rose Francis Foundation, we are committed to raising awareness about the important work we do to support women and children in our community. By signing this form, you are granting permission for the organization to use photos, videos, interviews, and other Media of you or your child if applicable at the discretion of the organization to continue to uphold our organizations mission.

I, (signature below), understand these images and materials may be used in public or private media and may appear in various forms, including but not limited to, photographs, videos, social media, and promotional campaigns. I, (signature below), grant Rose Francis Foundation the right to use my image, voice, and/or story in photos, videos, audio recordings, or written content for the following purposes;

I understand that I will not receive any compensation for the use of my image, voice, or story. I acknowledge that the organization will own the rights to the materials produced and that they may be shared or publishes without approval from me. I acknowledge that my participation is voluntary, and I may withdraw my consent at anytime by contacting the organization and requesting to update my consent preferences. I understand that any Media already produced or published prior to my withdraw may still be used. I confirm that I am the legal guardian or representative of any minors who image, voice, or likeness in included in this consent.