Harvesters Signup

All food is available at NO COST.
Todo la comida está disponible SIN COSTO ALGUNO.

Please give your name and the number of adults, children and seniors living in your household.
Por favor, dar su nombre y el número de adultos, niños y personas mayors que viven en suhogar.


I certify with my signature: I understand that the food available at this mobile food pantry is intended for families in need of food assistance. Need is defined in many ways including: being on some form of public assistance, being low income, and/or experiencing hardship(s) that make providing food for your household difficult.
Yo certifico con mi firma: Entiendo que la comida disponible en este sitio de distribucioń es pare familias con necesidad de ayuda alimentaria. La necesidad se define de las siguientes maneras: recibiendo una forma de ayuda publica, bahos ingresos, y/o estar pasndo por una situación

On occasion, a small amount of extra food is supplied through the federal TEFAP program.  We need to know how many households qualify for our records.  If you qualify, check the "TEFAP" box.  You will still receive food regardless of this selection.

  1. The income of my household does not exceed the posted guidelines (130% of the Federal Poverty Level)
  2. I will use USDA commodities for home consumptions only.
  3. I will not sell, barter, or inappropriately utilize USDA commodities in any manner
  4. I will not attempt to receive the same type of USDA commodities from more than one agency during any given calendar month.
  5. I understand that willfully and/or intentionally making a false statement, concealing or withholding information in order to receive food I am not eligible to receive may subject me to prosecution, ineligibility penalties and restrictions.

No personal data is stored.  It is solely used to generate a scannable code for the volunteers that you print or display on your mobile device.