LVFP 2026 Thanksgiving Meal Form

Thanksgiving Meal Box Registration

Before registering for a Thanksgiving Meal Box, please take the time to review the form below, indicating the financial guidelines for Federal and State Funded Food Programs Eligibility to Take Food Home. Continue to fill out this registration ONLY if you meet the following guidelines:
You may also click the red link below if it is difficult to read the guidelines above. Keep in mind that this will open a new window and you will need to come back here to complete your registration.

Federal and State Funded Food Programs Eligibility to Take Food Home

Thanksgiving Meal Box Registration

The following information is being collected to complete your registration for a Thanksgiving Meal Box in Pantry Trak. Note: This registration is for the Thanksgiving Meal Box delivery which can be (a) picked up, or (b) delivered provided you live within the Lancaster City Limits.
Personal Information
Name

First NameLast Name
Middle Name/Initial
Street Address
City
State
Zip Code
County

Contact Information
Home Phone #
(XXX) XXX-XXXX
Cell Phone #
(XXX) XXX-XXXX
Email Address
Birth Month
Birth Day
Birth Year
Gender

Household Details
How many other members are in your household?
How many total members are 60+ years old?
How many total members are between the ages of 18-59?
How many total children under the age of 18?

Household Member #8
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #7
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #6
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #5
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #4
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #3
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #2
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Household Member #1
Name

First NameLast Name
Middle Name/Initial
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Signature
Signature of Head of Household
Printed Name of Head of Household
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
How will you receive your Thanksgiving Food Box?

Proxy Shopper Form

A proxy is a person who picks up food for another person.
The person picking up the food must show the Letter of Proxy at registration.

Customer Information - Filled out by customer receiving food.
This letter is to certify that my household meets the current income guidelines for food assistance according to the “Federal and State Funded Food Programs Eligibility to Take Food Home Form.” I am not able to appear in person due to health, transportation issues or scheduling conflicts.
I give permission to the person listed below to sign my form in my absence.

I, Customer Printed Name* , (Customer – Print Name) authorize Lancaster Vineyard Food Pantry (Proxy Shopper – Print Name) to pick up and deliver food to me.

My Address:
Street Address:   Street Address*
City:   City*
County:   County*
Zip Code:   Zip Code*

My Phone Number: Phone Number*

How many People in My Household by Age:
Ages: 0-17: # of 0-17 Year Olds*, 18-59: # of 18-59 Year Olds*, 60+: # of 60+ Year Olds*

Proxy Information - Person who is picking up the food
Please complete the following information describing the proxy.

Proxy Name: Lancaster Vineyard Food Pantry

Phone Number: (740) 654-0964

Please Note: The Proxy will sign their name/initials on the eligibility form NOT the Customer Name.

Thank you for your assistance.

Sincerely,
Customer Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
THIS FORM MUST BE UPDATED ANNUALLY AND/OR IF HOUSEHOLD COMPOSITION CHANGES.

Proxy Shopper Form

A proxy is a person who picks up food for another person.
The person picking up the food must show the Letter of Proxy at registration.

Customer Information - Filled out by customer receiving food.
This letter is to certify that my household meets the current income guidelines for food assistance according to the “Federal and State Funded Food Programs Eligibility to Take Food Home Form.” I am not able to appear in person due to health, transportation issues or scheduling conflicts.
I give permission to the person listed below to sign my form in my absence.

I,    Customer - Print Name*   , (Customer – Print Name) authorize   Proxy Shopper - Print Name*   (Proxy Shopper – Print Name) to pick up and deliver food to me.

My Address:
Street Address:   Street Address*
City:   City*
County:   County*
Zip Code:   Zip Code*

My Phone Number:   My Phone Number*

How many People in My Household by Age:
Ages: 0-17:    # of 0-17 Year Olds*   , 18-59:    # of 19-59 Year Olds*   , 60+:   # of 60+ Year Olds*

Proxy Information - Person who is picking up the food
Please complete the following information describing the proxy.

Proxy Name:   Proxy Name*

Phone Number:   Phone Number*

Please Note: The Proxy will sign their name/initials on the eligibility form NOT the Customer Name.

Thank you for your assistance.

Sincerely,
Customer Signature
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
THIS FORM MUST BE UPDATED ANNUALLY AND/OR IF HOUSEHOLD COMPOSITION CHANGES.

Review

This is your chance to go back over your information and make sure it is accurate. Once you have reviewed your information, click submit.
Should be Empty:

Thanksgiving Meal Box Registration

Thanksgiving Meal Box Registration

Personal Information

Contact Information

Household Details

Household Member #8

Household Member #7

Household Member #6

Household Member #5

Household Member #4

Household Member #3

Household Member #2

Household Member #1

Signature

Proxy Shopper Form

Proxy Shopper Form

Review