Food Pantry Distribution Request Form

Food Pantry Distribution Request Form

Please complete the form below to request assistance from the Worship with Wonders Church Food Pantry.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Size of household*
Number of family members over 65*
Number of children*
Ages of children
Zip Code*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
How did you hear about our services?*
Our food pantry is open at the times below. Please submit a request at least 48 hours prior to your selected pick-up time. Do not make plans to arrive UNTIL YOU RECEIVE AN EMAIL confirming your exact pick up date and time.

MONDAY 11:00AM - 2:00PM; WEDNESDAY 6:00PM - 7:30PM; SATURDAY 12:00PM - 2:00PM, 6:30PM - 8:00PM
What day would you like to pick up your food package?*
An email will be sent confirming receipt of your request and your confirmed pick up time. Please allow up to 48 hours for a response. Your pick up is not confirmed until you receive a response.
Please note: In an effort to adequately support and supply our community with resources, households can request assistance ONCE (1x) every 30 days. Additional requests received before the 30 days will be evaluated based on need pantry supply availabilty.
Please include any additional information our team will need to know.
Should be Empty: