Food Pantry Food Choices Food Pantry Client Food Choices Question Title * 1. Please provide the following information. Name Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming 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. Please tell us the total number of people living in your household. Question Title * 4. Please tell us how many live in your household. Child (Ages 0-17) Adult ( Ages 18-59) Senior (Ages 60-110) Question Title * 5. Baby Club- To participate in our Baby Club and receive diapers, baby food, or other baby items, you must complete the Baby Club registration each month so that we know the child's sizes.We must receive a copy of the child's birth certificate or guardianship documents to participate. Please send that to:office@commreach.org Question Title * 6. Please choose 2 types of canned vegetables. Green Beans Corn Peas Beans Canned Spinach Mixed Vegetables Sliced potatoes Question Title * 7. Please choose canned fruit - limit 2 Applesauce Mixed Fruit Pears Peaches Mandarin Oranges Question Title * 8. Please choose canned meat - limit 2 Pork Beef Tuna Chicken Salmon Question Title * 9. Please choose soup - limit 2 Tomato Vegetable Chicken Noodle Cream Of Mushroom Cream Of Chicken Progress Steak and Veggies Beef Broth Chicken Broth Question Title * 10. Please choose your dry items (up to 6 items) Mexican Rice Potato Stroganoff Pancake Mix White Rice Brown Rice Tuna Helper Lasagna Helper Beef Hamburger Helper Spaghetti Ready Rice Cheddar Broccoli Mac & Cheese Elbow Macaroni Louisiana Chicken Fry Batter Mix Godiva Dark Chocolate Pudding Chicken Stuffing Cake Mix and Icing Taco Kit Question Title * 11. Please choose misc. items (up to 6 items) Spaghetti Sauce Chef Boyardee Beef Stew Peanut Butter Jelly Mild Taco Sauce Cereal Oatmeal Raisins Salty Snacks Pistachios Dates Apple Cider Vinegar Dressing & Marinade Crackers Hot Fudge Brownie Microwave Mug Mix Almonds Question Title * 12. Drinks - 1 coffee and 1 other drink Grapefruit Juice Apple Juice Diet Green Tea Assorted Lipton Sweet Tea Decaf Ground Coffee Caffeinated Ground Coffee Capri Sun Juice Boxes Gatorade Zero Berry Bottled Water Question Title * 13. Please choose dairy - as available, 1 cheese choice Milk Eggs Block Cheese Cheese Slices Swiss Cheese Question Title * 14. Please choose 1 freezer item Green Beans Corn Peas Cranberries Strawberry Waffles Question Title * 15. Please choose 2/3 meats Fish Filet Pork Loin Ground Beef Ham Steak 3 lb Ham Ground Turkey Chicken Quarters Hot Dogs Vegan Chicken Packs - various flavors Question Title * 16. Do you or anyone in your household have allergies?**Please note that our pantry does have peanut products with other pantry food.** Yes No Other (please specify) Question Title * 17. If you have any questions please send an email to:office@commreach.org or list below. Question Title * 18. Our pantry is extremely busy due to the cost of living and economy.If you miss your appointment without notifying us, we may cancel future appointments.All food distributed is based on availability of the food items that you choose. Yes I understand No I do not understand Question Title * 19. We reserve the right to cancel or reschedule appointments if you have not submitted your food choices at least 3 days before your scheduled to pick up food. We pack food boxes 2-3 days before your appointment so if we do not have your food choices when we are ready to pack your food, your appointment will be canceled. I will submit my food order at least 3 days prior to my food pantry appointment. I will submit my food order at least 3 days prior to my food pantry appointment. Question Title * 20. If you need to contact us please contact us via email. Due to the high volume of clients we are servicing at our food pantry, we may not be able to answer our phones. We check email periodically throughout the day.office@commreach.org Question Title * 21. Do you or anyone in your household have a birthday this month? If so, please list their name and birthday. All set! Thanks
