Pewaukee Food Pantry Client Intake Form

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Pewaukee Food Pantry Client Intake Form

Before clients can receive assistance from the food pantry, they must complete this form. Then, on your first visit to the food pantry, please bring a copy of a utility bill, a lease or something that proves that you live in the City or Village of Pewaukee.

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* Indicates required question

Email *

Your email

Name *

Your answer

Address *

Your answer

Phone *

Your answer

Number of adults in household *

Your answer

Number of children in household *

Your answer

Gender and birthdate for each child *

Your answer

Submit

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