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Food Pick-Up Registration
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* Indicates required question
I'd like to register for:
*
Daily breakfast and lunch pick-up (pick-up takes place on Monday, Wednesday, and Friday)
Weekly food pick-up
Both daily and weekly food pick-up
If you chose Weekly Food Pick-Up or Both Options please chose your pick-up time:
Saturday morning from 8:30-10 a.m.
Individual Appointment
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If you chose "individual appointment" above how would you like to be connected with Susan Dietrich, Director of the Medway Village Church Food Pantry?
I will email Susan:
mvcfp170@gmail.com
I'd like Susan to reach out to me (add phone number below)
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Parent, Guardian, or Adult's Name
Your answer
Parent, Guardian, or Adult's phone number
Your answer
Parent, Guardian, or Adult's Email
*
Your answer
The number of people under 21 that you will be picking up food for:
*
1
2
3
4
5
More than 5
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