New Pantry Food Order Choice Food Pantry Food Choices Food Choice Question Title * Please provide the following information Full Name Phone Number Email Address Question Title * Are you interested in any of the following adult education classes? Please select all that apply. GED/High School Diploma/ Hi Test Learning English(second language) Parenting Courses(Online) Anger Management Courses(Online) Family Dynamics Courses(Online) Cooking Classes Using Pantry Food For Ingredients None of the above Question Title * Which school district do you live in? Red Lion Dallastown Eastern York Question Title * Please tell us total number of people in your household that are registered with our agency? Question Title * How many seniors, How many adults, How many children? Question Title * Please choose meats. Up to 3 choices for families. Boneless Chicken Breasts Ham Steak Ground Beef Pork Chops Chorizo (Pork) Chicken Leg Quarters Pork Loin Hot Dogs Chicken Drumsticks Ground Turkey (after 7/5) Question Title * Please choose 2 freezer item Frozen Corn Frozen peas Frozen Cranberries Frozen Green Beans Frozen Spinach Zucchini Vegetable Spirals Frozen French Fries Chicken Parmesan Dinner Chicken Teriyaki Bowl Sugar Snap Peas Other (please specify) Question Title * Please choose your dairy items. One type of cheese per client. Fresh Milk (when available) Eggs (when available) Cheddar Cheese Shredded Cheddar Cheese (chunk) Swiss Cheese Question Title * Please choose 2 types of canned soups Tomato Vegetable Cream of chicken Chicken Rice Cream of Mushroom Chicken Noodle Soup Chicken Chili (after 7/5) Other (please specify) Question Title * Please choose up to 6 dry items Spaghetti Noodles Matzo Macaroni & Cheese Elbow Macaroni Mexican Rice Spanish Rice Pancake Mix White Rice Flour Helpers Beef Pasta Helpers Cheesy Tuna Helpers Stroganoff Sugar Other (please specify) Question Title * Please choose 2-3 types of canned vegetables Corn Creamed Corn Green Beans Peas Pork and Beans Other (please specify) Question Title * Please choose 1-2 canned meats Beef Pork Chicken Tuna Salmon Other (please specify) Question Title * Please choose up to 4 miscellaneous items Peanut Butter Jelly Spaghetti Sauce Canned Beans, black , kidney or pinto beans Chicken Broth Vegetable Broth Taco Dinner Kit Canned Chef Boyardee Italian Bottled Dressing (after 7/5) Other (please specify) Question Title * Please choose one type of cereal Cereal Oatmeal Granola Other (please specify) Question Title * Please choose 1 drink plus type of coffee Decaf Ground Coffee Caffeinated Ground Coffee Assorted Tea Bags K Cups Grapefruit Juice Cranberry Juice Cherry Apple Juice Orange Juice (after 7/5) Lemonade (after 7/5) Question Title * Please choose 2 snacks Granola Bars Crackers Pretzels or chips (as available) Sweet Snacks (as available) Raisins Pistachios Fruit and Nut Mix Question Title * Please choose 2 types of canned fruits Applesauce Mandarin Oranges Peaches (after 7/5) Pears Fruit Cocktail Other (please specify) Question Title * Do you or anyone in your household have any special dietary needs? If so, please explain Question Title * Would you like to get free diapers, wipes, baby food, and other baby items once a month? If so, you must register for our baby club. You must submit a copy of the child's birth certificate or guardianship paperwork to participate. It is very easy. Baby Club members, please list diaper, pull up and clothing sizes, formula type, food stages in box below. I understand that if I am interested I must register on the website. I am not interested. Other (please specify) Question Title * Are there any items that you do not want to receive from us? Do you need any of the following:Depends - list size List size depends if needed. Question Title * Please do not forget to schedule your pantry food pick up using the link on our website after you hit "CLICK HERE IF FINISHED" below. I understand Question Title * PLEASE NOTE***All selected food items are based on availability.Our building and pantry are exposed to nuts through various food products that we carry. Question Title * Do you or anyone in your household have a birthday this month? If so, please enter their name and date of birth in the text box below. Question Title * Do you feel safe at home? Yes No Other (please specify) Question Title * If you are a victim of abuse please call the YCWA hotline at 1-800-262-8444. Click Here If Finished