GoodRoots NW New Member Registration

New Member Registration

Membership is free and food is free. We welcome anyone living in Washington. Members shop online + pick up at a locker.Please register your household once.
TEFAP/USDA Info (Required)
By filling out this form and receiving USDA Foods, I self-declare:
1. Your name and household size provided is correct.
2. You live within this state. (There is no minimum length of residency required).
3. Your household income is at or below 400 percent of the Federal Poverty Guidelines (net, after taxes) as posted for the distribution.
4. You agree that TEFAP (USDA) food is for home consumption and the household is in need of this food.

All TEFAP clients must be informed of the following:
1. You will not be denied TEFAP (USDA) food if you do not wish to disclose any information that is not a requirement of TEFAP.
2. You will never need to provide your address, social security number, or identification.
3. You will never need to provide proof of citizenship, immigration status, household size, or income.
4. TEFAP (USDA) food is not for resale.
5. A copy of the full USDA Nondiscrimination Statement is available upon request.
Name

First NameLast Name
Total Number of Household Members
Is this your first time visiting a pantry in Washington State this calendar year?
Additional Info (Not Required)

This information is optional. You will ALWAYS receive food, but sharing it helps us with funding reports.
Your Birth Year
Your Race/Ethnicity
Second Household Member

First NameLast Name
Second HH Member - Birth Year
Second HH Member - Race/Ethnicity
Third Household Member

First NameLast Name
Third HH Member - Birth Year
Third HH Member - Race/Ethnicity
Fourth Household Member

First NameLast Name
Fourth HH Member - Birth Year
Fourth HH Member - Race/Ethnicity
Fifth Household Member

First NameLast Name
Fifth HH Member - Birth Year
Fifth HH Member - Race/Ethnicity
Sixth Household Member

First NameLast Name
Sixth HH Member - Birth Year
Sixth HH Member - Race/Ethnicity
Seventh Household Member

First NameLast Name
Seventh HH Member - Birth Year
Seventh HH Member -Race/Ethnicity
Eighth Household Member

First NameLast Name
Eighth HH Member - Birth Year
Eighth HH Member - Race/Ethnicity
Ninth Household Member

First NameLast Name
Ninth HH Member - Birth Year
Ninth HH Member - Race/Ethnicity
Tenth Household Member

First NameLast Name
Tenth HH Member - Birth Year
Tenth HH Member - Race/Ethnicity
Enter Birth Year & Race For Each Household Member (Begin with Self)
City - This ensures you will get a locker closest to you.
Are you currently enrolled at one of these colleges?
If enrolled above, please enter your student ID.
Phone Number
Format: (000) 000-0000.
Phone Type
Email (If you do not have email, please text or call us at 253-303-5909)

Confirmation Emailexample@example.com
Once you submit, you are officially a member. Look for an email confirmation from Smartchoice Pantry for how to order online and pick up at a locker nearest you.
Should be Empty:

New Member Registration

TEFAP/USDA Info (Required)

Additional Info (Not Required)

Once you submit, you are officially a member. Look for an email confirmation from Smartchoice Pantry for how to order online and pick up at a locker nearest you.