Open Seat Winter Break Order Form
This is the form to order food for Dec 21, 2022, and January 4, 11, and 18, 2023

PICKUP will be at: 

3rd Floor of the Student Activity Center 

333 E Campus Mall
Madison, WI 53715 
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Name *
E-mail *
“I understand that food distributed by The Open Seat has been donated from various on and off-campus sources and that none of the parties involved in the program make any warranties as to the quality of the food or its value for any particular purposes.  I will inspect the food I wish to take from the pantry to determine if it is fit for consumption and I voluntarily accept the food “as is.”  By my signature below, I release any liability or harm (including injury or death) or losses in connection with the food or supplies I have received. I assume any risks and covenant not to sue the released parties with respect to such harm or losses.”
 *
“I understand the Open Seat operates on limited funds and in support of others.  I will only request and take the items I reasonably expect myself and/or my family to use.  I also will not sell or offer for sale food obtained from The Open Seat."
 *
How many people are you supporting with this food order? *
How many people in your household are under the age of 18? *
How many people in your household are over age 65? *
What day are you planning to come pick up food?  Check all that apply.   You can still come even if you forget to order- this form will help us know how much food to have. *
Required
Do you plan to take an order of dairy foods (2-4 items)? *
Do you plan to take an order of fresh produce (2-4 items)? *
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