Women & Children's Shopper Registration

New Shopper Registration

Membership and services are free. We welcome anyone living in Washington. Shop online and pick up at WCFR lockers. 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?

YesNo
Additional Household Information

(Required)
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)
Select your yearly income range*
City - This helps us serve you better*
Phone Number*
Format: (000) 000-0000.
Phone Type*

CellularLandline
Email (must enter twice)*

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 your healthy meals and groceries from our refrigerated locker.
Should be Empty:

New Shopper Registration

TEFAP/USDA Info (Required)

Additional Household Information

Once you submit, you are officially a member. Look for an email confirmation for how to order online and pick up your healthy meals and groceries from our refrigerated locker.