Food distribution registration

Supplemental Food Distribution Registration Form

Fill out the form carefully for registration
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
How many in household?*
Additional Comments
Instructions for pickup day..

Pick up location will be in front of the fellowship hall at Pilgrim Rest Baptist Church. Address is 5995 Hwy 4 Baker, FL 32531. Follow signs for curbside pickup.

Please stay in car and have an area in your car ready for food bags.

Check flyer or facebook posts for pickup time and date.
Should be Empty:

Supplemental Food Distribution Registration Form