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Client Intake Form
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Name
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Street Address
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City, State, Zip code
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Home Phone Number
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Cell Phone Number
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E-Mail
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Please list the people in your home. Please list their name, M/F, age, and relationship to you.
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Are you receiving any other assistance?
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Yes
No
If Yes, please describe
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Would you like the ability to choose some of the food products you receive?
Yes
No
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Would you be interested in having a specified pick-up time for your food?
Yes
No
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If yes, please choose desired time-frame.
10am-10:20am
10:20am-10:40am
10:40am-11am
11am-11:20am
11:20am-11:40am
11:40am-12-noon
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Is there anything special we need to know about you or your family?
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How did you hear about the Lovell Area Food Pantry?
Your answer
The Lovell Area Food Pantry is run by volunteers within the community and its sole purpose is to help distribute healthy food to those in need.
We appreciate your patience and cooperation during our business hours.
We must keep everyone safe and require you to wear masks during food exchanges and communication with the staff.
Staff will bring your food to your vehicle.
We commit to treating all who come to the pantry with respect and dignity and we expect the same in return.
We reserve the right to turn away anyone who is verbally or physically abusive or have threatened harm to staff or other clients.
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