2025 Food Pantry Pick-Up Request Form (New Client)

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For best results use the Google Chrome Web Browser when completing this form.At this time masks are now optional for those who are fully vaccinated. Based on CDC Guidelines, we strongly recommend that those who have not been vaccinated wear masks. We believe that the privacy of individuals is important. Table of Hope food pantry does not collect or retain address or location information as part of this application.
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Are You a New Client of the Food Pantry?Choose YES if you have have never been to the Table of Hope Food Pantry before, or if you have not been to the food pantry in over 2 years. Choose NO if you have a curent Food Pantry Card and you are an existing client.
YESNO
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Name (Primary)* This field is required.Enter the first and last name of the primary (household) Table of Hope Food Pantry card holder.
First Name
Last Name
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Date of Birth (Primary)* This field is required.Enter the birth date (MM-DD-YYYY) of the Primary Household Client.
Date
Month
Day
Year
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Phone Number (Primary)* This field is required.Enter the phone number of the primary (household) Table of Hope Food Pantry client. This is the number we will use to contact you if there are any issues with your application or pick-up date and time.
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Additional Phone Number (Primary)You have the option of providing us with an additional phone number should we have any issue with your order.
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Email (Primary)Enter the email of the primary (household) Table of Hope Food Pantry card holder. We will use this to contact you if we cannot reach you by phone.
A confirmation email will be sent to this address
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Zip Code* This field is required.Enter the zip code of the primary (household) Table of Hope Food Pantry client.
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County* This field is required.Enter the county of the primary (household) Table of Hope Food Pantry client.
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Preferred Language (Primary)* This field is required.
English
Spanish
Vietnamese
Other
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Ethnicity (Primary)* This field is required.
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Other or Mixed
for grant writing purposes
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Gender (Primary)* This field is required.
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
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Total Number of People in Household* This field is required.Enter the number of people in your household. Be sure to include yourself. This form limits you to 9 entries. If there are more than 9 people in your household please call us at (316) 267-1852.
Including yourself
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Are there any military veterans in the household?* This field is required.To be counted, the veteran must be included in the total number of people in the household you gave in the previous question. The answer to this question will help with our grant funding requests and will have no impact on the amount or type of food given.
YESNO
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Next you will be asked to enter the following information for all other members of your household.

Name

Date of Birth

Gender

Ethnicity

Relationship to you
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When you come for your appointment, you will also be asked to show identification (an ID) for each member of your household listed on your application. Table of Hope does not copy or retain any identification information, this is just to verify the number of people in your household.

For those 18 years and older you must bring a picture of a PHOTO ID (State Driver's License, State ID, National ID, Passport, Consulate ID)

For those 17 years older or younger you may bring a picture of a NON-PHOTO ID (Insurance Card, Birth Certificate, Shot Record, Social Security Card)
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Name (Other in Household 1)
First Name
Last Name
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Date of Birth (Other in Household 1)
Date
Month
Day
Year
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Ethnicity (Other in Household 1)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 1)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 1)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 2)
First Name
Last Name
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Date of Birth (Other in Household 2)
Date
Month
Day
Year
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Ethnicity (Other in Household 2)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 2)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 2)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 3)
First Name
Last Name
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Date of Birth (Other in Household 3)
Date
Month
Day
Year
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Ethnicity (Other in Household 3)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 3)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 3)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 4)
First Name
Last Name
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Date of Birth (Other in Household 4)
Date
Month
Day
Year
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Ethnicity (Other in Household 4)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 4)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 4)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 5)
First Name
Last Name
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Date of Birth (Other in Household 5)
Date
Month
Day
Year
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Ethnicity (Other in Household 5)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 5)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 5)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 6)
First Name
Last Name
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Date of Birth (Other in Household 6)
Date
Month
Day
Year
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Ethnicity (Other in Household 6)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other In Household 6)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 6)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 7)
First Name
Last Name
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Date of Birth (Other in Household 7)
Date
Month
Day
Year
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Ethnicity (Other in Household 7)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (Other in Household 7)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 7)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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Name (Other in Household 8)
First Name
Last Name
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Date of Birth (Other in Household 8)
Date
Month
Day
Year
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Ethnicity (Other in Household 8)
Asian
African American or Black
Caucasian or White
Native American or American Indian
Native Hawaiian or Pacific Islander
Latino or Hispanic
Other or Mixed
for grant writing purposes
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Gender (other in Household 8)
Male
Female
Transgender Male (F to M)
Transgender Female (M to F)
Other
Choose not to disclose
for grant writing purposes
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Relationship to Applicant (Other in Household 8)
Enter the relationship of this person to you (son, daughter, cousin, etc.).
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ATTENTION!!!!

FOOD DISTRIBUTION IS ONLY AVAILABLE BY APPOINTMENT.

On the next screen you will select an apointment time. CHECK THE DATE CAREFULLY!

ONLY AVAILABLE TIMES ARE LISTED. IF ALL SLOTS ARE FULL THE SELECTION CALENDAR WILL AUTOMATICALLY MOVE TO THE NEXT WEEK (YOU COULD BE MAKING AN APPOINTMENT FOR THE FOLLOWING WEEK BY MISTAKE).

Choose a different time, schedule for another week or call (316) 267-1852 to speak with a scheduling volunteer.

We may close early or change appointment availability at our discretion - this is why appointments are so important! We always do our best to make times available for you. Food pantry volunteers stand and work outside to serve you so weather has a big impact on our ability to operate. Extremely hot or cold days or other inclement weather events will likely result in reduced appointment availability.
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Appointment* This field is required.Choose an appointment time, You have a 20-minute window to pick-up your food (for example if you select 11:00 am you will have from 10:50-11:10 am to pick up your order). Online appointments must be made at least 24 hours in advance. ONLY AVAILABLE TIMES ARE LISTED BELOW. If a time does not appear, this means all slots in that time frame are full. Choose a different time, schedule for another week or call (316) 267-1852 to speak with a scheduling volunteer.
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Dogs/Cats? (optional)We are able to provide one small bag of dog food, and/or cat food and cat litter per household per visit (based on availability). Check the appropriate box(es) below. If you don't have any pets, click next to move to the next screen.
Dog Food
Cat Food
Cat Litter
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We have everything we needWe will NOT call to confirm your appointment unless there is an issue with your order. Please arrive within 30 minutes of the time you selected. If for any reason you need to cancel your appointment call us at (316) 267-1852 and speak with a volunteer or leave us a message. CHECK THE EMAIL ACCOUNT YOU ENTERED ABOVE FOR A CONFIRMATION MESSAGE. THIS WILL LET YOU KNOW YOUR REQUEST WENT THROUGH. THIS FORM WORKS BEST WITH GOOGLE CHROME.
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You should be a new client of the Table of Hope Food Pantry to use this form. If you have used our services complete the Food Pantry Pick-Up Request Form (Existing Client).
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