Food Bank Form — Hope Community Trust

Food Parcel Request Form

The Hope Community Food Bank is located in Rangiora, North Canterbury and is here to provide support to the North Canterbury Region.

It provides support for any person/family no matter what circumstances, that may need some extra help, this is not a means tested service. Whether redundancy, illness, benefit delay, extra bills or any other reason
we are here to help. Please provide contact details and we will be in touch by the next business day.

Date of Request

Please add the date you require a food parcel.

YYYY

Name

Note: Only one food parcel per address.

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number in Family

Have you received a food parcel in the past?

Additional Information

Please add if there is any special requirements.

Disclaimer

The food and produce in this food parcel have been sourced from various food outlets and manufacturers and maybe seconds, damaged or indicate use by dates, which may leave some products with a minimum of safe life. Every attempt has been made to ensure this parcel arrives to you in a safe and usable condition but the final assessment by you, the recipients before consumption is essential. I therefore accept the items contained in this parcel have been donated and intended solely for the use of the recipient/s and must not be sold or traded. I do not hold liable in any way whatsoever any donor who has contributed to the provision of this parcel including Hope Community Trust, food outlets and manufacturers. Your acceptance of this disclaimer is a pre-condition to your acceptance of this food parcel and by way of ticking the box, it is taken as acceptance of conditions.

I Accept