Village Hills Fellowship

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A volunteer is happy to help if you'd like a hand. Your answers save automatically on this device, so you can come back to them if you need to stop.

Basic information

For fields that do not apply, enter None. * Required

First name *

Last name *

Visit date *

Address

Street address *

City *

State *

ZIP code *

County *

Contact

Email address *

Phone number *

Preferred communication *

May we contact you about pantry services? *

YesNo

Would you like information about other resources? *

YesNo

No ID is required.

Household

Other household members who will benefit today (not including yourself) *

Does anyone in your household receive SNAP or food stamps? *

Other government programs received (select all that apply) *Free/reduced price school mealsMedicaidSupplemental Security Income (SSI)TANF or cash assistanceUnemploymentWomen, Infants, and Children (WIC)NoneDon't know / Prefer not to answer

Household income

Choose one time period and enter your household income amount. Enter 0 if none.

Income time period *

Household income ($) *

Is your household in crisis? (optional)

YesNo

More about your household

Age *

Gender identity *

Race / ethnicity (select all that apply) *WhiteHispanic, Latino, or SpanishBlack or African AmericanAsianAmerican Indian or Alaska NativeMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderSome other race or ethnicityDon't know / Prefer not to answer

Authorization to Register with the San Antonio Food BankI authorize Village Hills Fellowship food pantry staff and authorized volunteers to use the information I provide on this form to register or update my household’s information in the San Antonio Food Bank system for food assistance and related reporting. I understand that this information will be shared with the San Antonio Food Bank for those purposes. *

Your answers are available to authorized pantry staff and volunteers and shared with the San Antonio Food Bank as described above. You do not need ID to receive help.

Village Hills Fellowship · 207 Lee St Schertz, TX 78154

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Pantry Sign is a ministry of Spiritual Combatants.