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Food Pantry / Soup Kitchen Registration

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Name of person providing the information below.
Phone number of person providing the information below.
Email of person providing the information below.
Are you registering a Food Pantry or a Soup Kitchen?
- Food Pantry
- Soup Kitchen
Food Pantry or Soup Kitchen Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Phone 2
FAX
TTY Number
Coordinator's Name and Title:
First Last

Service Hours:
Days:
Frequency (i.e. 3rd Saturday of the month):
Is the service closed during any specific times of the year?
Do you serve people who speak a language other than English? If yes, what languages are spoken?
Is there a specific population, or age range served? (i.e. Just families; just seniors)
What is the specific area served? (list the towns or the region / community / neighborhood / zip code(s) )
Can people walk in?
- Yes
- No
Is an appointment required?
- Yes
- No
Do people need to bring their own bag?
- Yes
- No
Do you accept food donations?
- Yes
- No
Does your agency/sites have disability access?
- Yes
- No
What features are available?
- Braille in elevators
- Handicap parking available
- Handicap accessible bathrooms
- Ramps
- Wheelchair accessible
- ADA compliant
Do you accept volunteers?
- Yes
- No
If yes, how old do the volunteers have to be?
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211 is a program of United Way of Connecticut and is supported by the State of Connecticut and Connecticut United Ways.