The Undercover Pantry Sign up - Harrisonburg / Rockingham County
The following information will be used to determine what products are needed for our monthly pantry and how to contact any pantry users to inform you of pickup instructions.

There are no income requirements to receive products from the pantry however, 
  • each household will be allotted one sign up for products per pantry opening. 
  • Product donations are limited to members of your household; if you have a relative who could benefit from pantry products, you can also encourage them to sign up their household for the pantry.
La siguiente información se utilizará para determinar qué productos se necesitan para nuestra despensa mensual y cómo contactar a los usuarios de la despensa para informarle las instrucciones de recolección. No hay requisitos de ingresos para recibir productos de la despensa; sin embargo, a cada familia se le asignará una recolección de productos por apertura de despensa.

Our address is: 36 Southgate Court, Harrisonburg, VA 22801


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Untitled Title
What is your name? *
Su nombre? 
Contact information
Please provide a method of contact for RFS to inform you about the time and date of the pantry and to provide instructions for pickup.

Información del contacto - Proporcione un método de contacto para que RFS le informe sobre la hora y la fecha de la despensa y le proporcione instrucciones para la recogida.
What is your e-mail?
Tu correo electrónico?
What is your phone number?
Su teléfono?
Please read and acknowledge the following information about item pickup
In order to continue to meet the growing needs of Undercover Pantry users, items will need to be picked up from RFS by Friday, end of business day(6pm) the week the pantry opens(First Wednesday of the month).

If your items are NOT picked up or if you have not contacted RFS about an alternate pickup option, we will not be able to hold on to the items and you will have to wait until the next Undercover Pantry opening.

 Para continuar satisfaciendo las crecientes necesidades de los usuarios de Undercover Pantry, los artículos deberán retirarse de RFS antes del viernes, al final del día hábil (6 p. m.), la semana en que abre la despensa (primer miércoles del mes). Si sus artículos NO se recogen o si no se ha comunicado con RFS sobre una opción de recogida alternativa, no podremos retener los artículos y tendrá que esperar hasta la próxima apertura de la despensa encubierta.

With any questions about this policy, please contact us at admin@riversidefamilysupport.com 
I have read the above statement regarding pickup of my items. *
He leído la declaración anterior con respecto a la recogida de mis artículos.
Required
If you are picking up items on our pantry day what time of day can we expect you? (We will text you to confirm the Monday before the pantry opens)

If you need to change your time, please let us know via text or email when you are contacted to confirm your pickup slot.
Si está recogiendo artículos en nuestro día de despensa, ¿a qué hora del día podemos esperarlo? (Le enviaremos un mensaje de texto para confirmar el lunes antes de que abra la despensa)
Clear selection
If you are unable to pick up items and prefer drop-off, what is your address? 

Please select this option ONLY if transportation is unavailable to you. RFS is located conveniently near a HDPT bus stop (Stop #187 - Routes 5 & 6) on East Market Street.

Si no puede recoger artículos y prefiere dejarlos, ¿cuál es su dirección?

Seleccione esta opción solo si el transporte no está disponible para usted. RFS está convenientemente ubicado cerca de una parada de autobús HDPT (parada #187, rutas 5 & 6) en East Market Street.
What products are you looking to receive from the pantry for members of your household? *
What menstrual products are you interested in?
¿Qué productos menstruales necesitas?
 *
Required
How many household members are in need of menstrual products? (REQUIRED if you are requesting menstrual products)
¿Cuántos miembros del hogar necesitan productos menstruales? (OBLIGATORIO si solicita productos menstruales)
How many children in your home wear diapers? (REQUIRED if you would like to receive diapers)
¿Cuántos niños en su hogar usan pañales? (REQUERIDO si desea recibir pañales)
Select the size of diapers you need
Are there any material allergies for anyone who would use the products?
¿Hay alguna alergia a los materiales para cualquiera que use los productos?
The following questions will be used to continue to grow our pantry and to determine the needs for these items in our community.
Responses to the questions below are VOLUNTARY and are not required to receive pantry donations. Answers to these questions will not impact the amount/kinds of product you receive.  - If you would like to opt out of these questions, please scroll to the bottom of the page and click "Submit".  Thank you!

Las siguientes preguntas son voluntarias. no es necesario que las responda para recibir productos. las preguntas nos ayudan a conocer las necesidades de nuestra comunidad. Si no desea responder, desplácese hasta la parte inferior de la página y haga clic en "Submit". Gracias!
What other products/supplies or supports/programs do you feel are lacking in our community for families in need?
¿Qué otros productos/suministros o apoyos/programas cree que faltan en nuestra comunidad para las familias necesitadas?
What is your occupation? 
Thank you for signing up! Here is a reminder of what to expect: 

Gracias por registrarte! Aquí hay un recordatorio de lo que puede esperar:

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