Summer Break food Distribution Registration Form

Summer Break Supplemental Food Distribution Registration Form

Apply here for food assistance through the Backpack Buddies program.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Total Number of People in Household
Additional comments
Instructions for pickup day on 6/5/26 & 7/10/26 from 5-7pm...

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

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

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

Summer Break Supplemental Food Distribution Registration Form