Harper’s Family Pantry – Food Assistance Registration

Harper’s Family Pantry – Food Assistance Registration

Complete this form to help FCCMI prepare for first-come, first-served assistance for families in Gwinnett County—availability and specific items can’t be guaranteed.
Head of Household Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP Code
Preferred contact method
Household size
Number of children under 18
Number of adults ages 18–59
Number of adults age 60+
Is this your first time receiving assistance from Harper’s Family Pantry?
Which type(s) of assistance are you seeking?

Other
Food allergies or dietary considerations (Please note that FCCMI cannot guarantee availability of specific foods or accommodation of every dietary need.)
Which distribution location/event do you plan to attend?
Transportation/accessibility or language accommodation needs (optional)
Additional information you would like us to know (optional)
Pantry Registration Acknowledgment
Information is provided voluntarily for program administration and service coordination. Assistance is based on available resources and is not guaranteed; food and other items may vary. Registration does not reserve food. Recipients should follow distribution instructions and treat volunteers and other families respectfully.
I have read and understand the Pantry Registration Acknowledgment.
I consent to FCCMI using my contact information to communicate about this request, pantry distributions, schedule changes, and related FCCMI community resources.
Optional text message updates

I agree to receive text messages from Fully Committed Christian Ministries International, Inc. (FCCMI) about my food assistance request, pantry distribution schedules, cancellations, registration updates, and related pantry reminders. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Texting consent is not a condition of receiving food or other assistance.
For help, contact info@fccmiinc.org or call 470-260-6065. FCCMI does not sell or share mobile numbers or SMS consent for third-party marketing. Privacy Policy: visit fccmiinc.org and select Privacy Policy in the footer.
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