Mobile Community Pantry Membership Registration Form

Mobile Community Pantry Membership Registration Form

Please fill out the form below, select your preferred location and date.
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Address*

Address Line 1

Address Line 2

City

Post Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Household
Adults*
Children
Income
Please select which income you receive?*

Employed IncomeUniversal CreditPensionDLA/PIPOther
Pantry Location

Please select which Family Hub location you like to become a member of.
Select Your Location*
Please select which Family Hub location you like to become a member of.
I agree that membership to the Mobile Food Pantry is free.

I am aware that a small fee per visit to the Mobile Food Pantry will be £2, members at of the Mobile Food Pantry will be able to purchase a weekly food shop including fresh fruit and vegetables and family favourites to stock up the cupboard and fridge.

I understands that the information collected on this membership form will be stored by We Care UK in accordance with our organisations policies and may be used and shared with partners for impact evaluation and funders reports.
I Agree
Should be Empty:

Household