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
Additional Household Members (if not, select 0)*
Is this your first time visiting a pantry in Washington State this calendar year?

YesNo
Additional Info (Not Required)

This information is optional. You will ALWAYS receive food, but sharing it helps us with funding reports.
Your Birth Year & Race:
Enter Birth Year & Race For Each Household Member
City - This ensures you will get a locker closest to you.
Are you currently enrolled at one of these colleges?

Bates Technical College, South CampusPierce College, Puyallup Campus
If enrolled above, please enter your student ID.
Phone Number
Phone Type

CellularLandline
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 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 for how to order online and pick up at a locker nearest you.