LVFP 2025 Thanksgiving Meal Form

Thanksgiving Meal Box Registration

Before registering for a Thanksgiving Meal Box, please take the time to review the form below, indicating the financial guidelines for Federal and State Funded Food Programs Eligibility to Take Food Home. Continue to fill out this registration ONLY if you meet the following guidelines:
You may also click the red link below if it is difficult to read the guidelines above. Keep in mind that this will open a new window and you will need to come back here to complete your registration.

Federal and State Funded Food Programs Eligibility to Take Food Home
I agree that I have read and meet the above income guidelines to receive a Thanksgiving Meal Box.

Thanksgiving Meal Box Registration

The following information is being collected to complete your registration for a Thanksgiving Meal Box in Pantry Trak. Note: This registration is for the Thanksgiving Meal Box delivery which can be (a) picked up, or (b) delivered provided you live within the Lancaster City Limits.
Personal Information
Name*

First NameLast Name
Middle Name/Initial
Street Address*
City*
State*
Zip Code*
County*

Contact Information
Home Phone #

Area CodePhone Number
Cell Phone #*

Area CodePhone Number
Email Address
Birth Month*
Birth Day*
Birth Year*
Gender*

MaleFemale

Household Details
How many other members are in your household?*
How many total members are 60+ years old?*
How many total members are between the ages of 18-59?*
How many total children under the age of 18?*

Signature
Signature of Head of Household*

Clear
Printed Name of Head of Household*
Today's Date*

MonthDayYear
How will you receive your Thanksgiving Food Box?*
I understand that I must fill out a proxy form (included in this registration) if someone other than myself or someone in my household is picking up my meal box. No meal boxes will be given out without a proxy form on file.

Food Pantry or Produce Market - Proxy Shopper Forms

The Thanksgiving Delivery Proxy Form must be completed in order for us to deliver your Thanksgiving Holiday Box.
The person picking up the food must show the Letter of Proxy at registration. The person picking up the food must have their own valid photo ID.

Release (customer receiving food)
This letter is to certify that my household meets the current income guidelines for food assistance according to the “Federal and State Funded Food Programs Eligibility to Take Food Home Form.” I am not able to appear in person due to health issues or scheduling conflicts. I give permission to the person listed below to sign my form in my absence:

I, Customer's Printed Name* , (Customer – Print Name) authorize Lancaster Vineyard Food Pantry (Proxy Shopper – Print Name) to pick up and deliver food from the Pantry Program to me.

My Address: Full Address*

My Phone Number: Phone Number*

How many People in My Household by Age:
Ages: 0-17: # of 0-17 Year Olds*, 18-59: # of 18-59 Year Olds*, 60+: # of 60+ Year Olds*

Proxy Information
Please complete the following information describing the proxy.

Proxy Name: Lancaster Vineyard Food Pantry

Phone Number: (740) 654-0964

Please Note: The Proxy will sign their name/initials on the eligibility form NOT the Customer Name.

Thank you for your assistance.
Sincerely,
Customer Signature*

Clear
Today's Date*

MonthDayYear
THIS FORM MUST BE UPDATED ANNUALLY AND/OR IF HOUSEHOLD COMPOSITION CHANGES.

Food Pantry or Produce Market - Proxy Shopper Forms

The Thanksgiving Delivery Proxy Form must be completed if someone else will be picking up your Thanksgiving Box. You must complete the Pick-Up Proxy Form with their information and the must show their ID when picking up your box.
The person picking up the food must show the Letter of Proxy at registration. The person picking up the food must have their own valid photo ID.

Release (customer receiving food)
This letter is to certify that my household meets the current income guidelines for food assistance according to the “Federal and State Funded Food Programs Eligibility to Take Food Home Form.” I am not able to appear in person due to health issues or scheduling conflicts. I give permission to the person listed below to sign my form in my absence:

I, Customer Printed Name* , (Customer – Print Name) authorize Proxy's Name* (Proxy Shopper – Print Name) to pick up and deliver food from the Pantry Program to me.

My Address: Full Address*

My Phone Number: Phone Number*

How many People in My Household by Age:
Ages: 0-17: # of 0-17 Year Olds*, 18-59: # of 18-59 Year Olds*, 60+: # of 60+ Year Olds*

Proxy Information
Please complete the following information describing the proxy.

Proxy Name: Proxy Name*

Phone Number: Phone Number*

Please Note: The Proxy will sign their name/initials on the eligibility form NOT the Customer Name.

Thank you for your assistance.
Sincerely,
Customer Signature*

Clear
Today's Date*

MonthDayYear
THIS FORM MUST BE UPDATED ANNUALLY AND/OR IF HOUSEHOLD COMPOSITION CHANGES.

Review Information

This is your chance to go back over your information and make sure it is accurate. Once you have reviewed your information, click submit.
Should be Empty:

Thanksgiving Meal Box Registration

Thanksgiving Meal Box Registration

Personal Information

Contact Information

Household Details

Additional Household Members

Signature

Food Pantry or Produce Market - Proxy Shopper Forms

Food Pantry or Produce Market - Proxy Shopper Forms

Review Information