Mercy Culture Food Pantry

Requirements:

Complete this form.
Book your appointment. Link to book your appointment will be sent to your email once this form is submitted.
Bring a valid ID at pick-up.

Requisitos

Complete este formulario.
Después de enviarlo, recibirá un correo electrónico con un enlace para programar su cita.
Traiga una identificación válida al momento de recoger los alimentos.

Appointment Times: A link will be sent to your email once this form is completed.

Wednesday (Senior's 55+): 10:15am - 12:45pm
Thursday (Adults 18+): 2:30pm - 4:30pm

Important Notes:

When a red star is present, that box MUST be filled in or your form will be rejected.
Only 1 person per household may be receive food each week.
Services are available to Merced County residents only.
No appointment? We can only offer a brown bag lunch, not a full food distribution.
Forms expire every Sunday; a new form must be submitted each week/visit.

Your name *

Email address *

Phone number *

Address *

FOOD ALLERGIES *

If allergies are listed, we will do our best to ensure you are not receiving items with those ingredients

Do you have a WORKING FRIDGE & can properly store refrigerated foods? *

Yes, I have a working fridge I can safely store food for long periods of time

No, I can't properly store refrigerated food

Do you have a WORKING STOVE / OVEN & can properly cook raw foods? *

Yes, I have a working stove and/or oven & I can safely cook food in

No, I can't properly cook raw foods

Food suggestions

If available, we will try to give you the items suggested below. Be specific when possible (formula, dog/cat food, kids snacks... etc)

Date of your last visit

If this is your first visit, disregard

Please share how you heard about us

Release Liability *

To the fullest extent permitted by law, I hereby release, discharge, and hold harmless Mercy Culture Assembly of God, it's food pantry, its staff, volunteers, directors, officers, agents, and affiliates, as well as the facility hosting the pantry (the "Released Parties"), from any and all claims, liabilities, injuries, damages, or losses arising out of or in any way related to my participation in pantry activities, including but not limited to foodborne illness, property damage, personal injury, or any other consequence resulting from my participation.

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