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F1 - Apply for registration as a Sevenoaks Larder client
In registering with us, we will assume that you are happy for us to share your details with any volunteers who will deliver to you on our behalf. These details will be deleted as soon as you are no longer registered with us.
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* Indicates required question
Email
*
Your email
Full Name - first name & surname
*
Your answer
Address
*
Your answer
Contact number
*
Your answer
Number of adults in household
*
1
2
3
4
5
6
Number of children in household
*
0
1
2
3
4
5
From time to time we get specific boy/girl or age related products donated. If you would like to take advantage of any of these, please tell us the age /sex of the children in your household. (This question is not compulsory.)
Your answer
Are there any adults aged over 65 in your household?
*
Your answer
Do you receive, or have you applied for, any government benefits?
*
Yes
No
If yes above, which benefits do you receive/have you applied for? (If none, just put N/A)
*
Your answer
If you are not in receipt of any means tested benefits (or waiting to hear about benefits), please tell us your usual household income per month (after tax)
*
Your answer
Please give details of any other food support that you receive (if none , just put N/A).
*
Your answer
If you live in a housing association property, please tell us which one (eg West Kent Housing)
*
Your answer
What is your main reason for needing our support? (eg debt, ill health, problems with benefits, out of work, ill health etc)
*
Your answer
Are you getting help from any other advice or support agencies with your situation (eg CAB etc)? If so, which ones?
*
Your answer
When are you able to come to the Larder to collect your food?
*
Tuesday afternoon
Thursday afternoon
I am unable to get to the Larder myself
Required
If you have indicated that you are unable to get to the Larder yourself , please give us a brief explanation as to why that is. There may be a waiting list for a delivery slot.
*
Your answer
Does anyone in the family have any allergies that you would like us to note?
*
Your answer
Does anyone in the family have any specific dietary requirements that you would like us to note?
*
Your answer
Does anyone in the family have any other health/mobility issues that you would like us to note?
*
Your answer
Do you have a dog or cat in the household? If so, what do they eat?
*
Dog - dry food
Dog - tinned/pouch food
Cat - dry food
Cat - tinned/pouch food
No dog/cat
Required
What cooking facilities do you have?
*
Oven
Hob
Microwave
Other
Other:
Required
Do you have access to a car?
*
Yes
No
Sometimes
Certain GP surgeries offer particular support for their own patients. If you would like us to know this information, please tell us which doctors' surgery you are registered with. (This question is not compulsory)
Your answer
Certain schools offer additional support for their own pupils' families. If you would like us to know this information, please tell us which schools your children attend if they are of school age. (This question is not compulsory).
Your answer
How/where did you hear about us?
*
Your answer
Anything else you would like us to know about your situation/household?
*
Your answer
A copy of your responses will be emailed to the address you provided.
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