CHOICE FOOD PANTRY COMMUNITY REACH INC FOOD PANTRY FOOD CHOICES Question Title * 1. PLEASE PROVIDE THE FOLLOWING INFORMATION Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. WHICH SCHOOL DISTRICT DO YOU RESIDE IN? RED LION DALLASTOWN EASTERN YORK Question Title * 3. HOW MANY PEOPLE RESIDE IN YOUR HOUSEHOLD? Question Title * 4. PLEASE TELL US HOW MANY HOUSEHOLD MEMBERS ARE IN EACH AGE GROUP BELOW CHILD (AGES 0-17) ADULT (AGES 18-59) SENIORS(AGES 59 AND OVER) Question Title * 5. PLEASE CHOOSE 2 TYPES OF CANNED VEGETABLES CORN GREEN BEANS PEAS BEANS YAMS/SWEET POTATOES CARROTS ASPARAGUS Question Title * 6. PLEASE CHOOSE UP TO 2 CANNED FRUITS APPLESAUCE FRUIT COCKTAIL PEACHES MANDARIN ORANGES PEARS Question Title * 7. PLEASE CHOOSE UP TO 2 CANNED MEATS BEEF PORK TUNA CHICKEN SALMON Question Title * 8. PLEASE CHOOSE UP TO 2 DIFFERENT CANS OF SOUP CHICKEN/BEEF BROTH CHICKEN NOODLE TOMATO VEGETABLE BEEF STEW CHICKEN CHILI CHICKEN RICE CREAM OF CHICKEN CREAM OF MUSHROOM Other (please specify) Question Title * 9. PLEASE CHOOSE UP TO 10 DRY GOODS RICE INSTANT POTATOES SPAGHETTI NOODLES ASSORTED PASTA NOODLES FLOUR ASSORTED SIDES (PASTA OR RICE) LASAGNA HELPER CHEESEBURGER HELPER TUNA HELPER ELBOW MACARONI TACO SHELLS ALFREDO MIX CHOCOLATE MUFFIN MIX CHOCOLATE CHIPS Question Title * 10. PLEASE CHOOSE 1 DRINK TEA BAGS IZZE SPARKLING JUICE DeCaf K CUPS GROUND COFFEE DECAF GROUND COFFE APPLE JUICE SALTED CARAMEL MOCHA K CUPS Question Title * 11. PLEASE CHOOSE UP TO 6 CHOICES TOMATO/SPAGHETTI SAUCE DICED TOMATOES/CRUSHED TOMATOES JELLY WALNUTS ALMONDS PUMPKIN PIE FILLING GRANOLA BARS SLOPPY JOE SAUCE CHEF BOYARDE PANCAKE MIX PANCAKE SYRUP MISC CONDIMENTS - May include: MAYO, SALAD DRESSING, KETCHUP VEGETABLE SHORTENING Question Title * 12. PLEASE CHOOSE YOUR 4 DAIRY OPTIONS . MILK EGGS CHEESE COCONUT OIL SPREAD VEGETABLE OIL SPREAD Question Title * 13. PLEASE CHOOSE 1 FREEZER ITEM TACOS BROCCOLI LEAN CUISINE SPAGHETTI MIXED VEGGIES - AFTER 3/28 GARLIC CHEDDAR BISCUITS PEAS Question Title * 14. PLEASE CHOOSE 3 MEATS GROUND BEEF VENISON CHICKEN QUARTERS HAM STEAK HOT DOGS (after 3/28) FISH FILLET CHICKEN DRUMSTICKS PORK LOIN FISH STICKS SAUSAGE GROUND BUFFALO/VENISON RIB STEAK/SHOULDER ROAST SHREDDED CHICKEN - after 3/28 Question Title * 15. DO YOU OR ANYONE IN YOUR HOUSEHOLD HAVE ANY ALLERGIES? IF SO, PLEASE PROVIDE DETAILS Question Title * 16. DUE TO THE HIGH VOLUME OF CLIENTS WE ARE NOW SERVICING, WE MAY NOT BE ABLE TO ANSWER THE PHONE OR RETURN CALLS UNTIL THE NEXT BUSINESS DAY. IF YOU HAVE QUESTIONS OR CONCERNS PLEASE SEND AN EMAIL TO OFFICE@COMMREACH.ORG Yes No Question Title * 17. DO YOU HAVE A BABY CLUB PICKUP WITH THIS ORDER? IF YOU WOULD LIKE TO REGISTER FOR OUR BABY CLUB PLEASE VISIT OUR WEBSITE. YOU MUST SUBMIT A BIRTH CERTIFICATE OR GUARDIANSHIP DOCUMENTS PRIOR TO YOUR FIRST BABY CLUB PICKUP. EACH AND EVERY MONTH YOU MUST SUBMIT THE BABY CLUB REQUEST FORM ON OUR WEBSITE. Yes No Question Title * 18. DOES ANYONE IN YOUR HOUSEHOLD HAVE A BIRTHDAY THIS MONTH? IF SO, PLEASE LIST THEIR NAME AND DOB. Question Title * 19. Click this link to schedule your food pantry appointment. If you have any questions, please put them in the contact box. We reserve the right to cancel any appointment without a food order.https://app.10to8.com/book/fqnyvhjqrihemjcotl/1276825/ Done