Mount Vernon Baptist Church Food Distribution

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the form below. Be sure to complete ALL sections.

You can either sign-up to be on the permanent list or to pick-up week by week. If you select the permanent option you do not have to sign up each month. Please be sure to let us know if you no longer need the food pantry and would like to be removed from the permanent list. If you choose to sign-up for individual weeks, you will be asked to complete a slot on the form. Thank you!

To receive your food, pull to door 5. It is located at the back of the Multipurpose Building. Make sure you if you arrive early, to wait in your car until 10:00. There will be additional rules upon arrival.

First & Last Name - Food Recipient *

Recipient address: street and city *

Recipient address: zip code *

Phone *

Are you a member at Mt. Vernon Baptist Church? *

Yes

Do you have children in your house who need diapers? *

Yes

If you answered "YES" to needing diapers, provide the size you would need. Please note that if we are able to distribute diapers, we can only give one pack per family. *

Size 1

Size 2

Size 3

Size 4

Size 5

Size 6

N/A - diapers not needed

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms