Friendsgiving Registration
Must be present to receive groceries. Items not claimed by 2:15pm will be given to those waiting.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
City of Residence
*
Newark
Other
E-mail
*
example@example.com
Phone Number
-
Area Code
Phone Number
Choose 1 Protein
*
Please Select
Turkey
Ham
Chicken
Turkeys, Hams & Chickens unclaimed/additional will be first come first serve at 2:30pm.
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Household Information
This Information provided through this form is used to assist UCC in expanding the services we provide by identifying the demographics of the clients we serve.
Household Income
*
Please Select
No Income to $12,000
$26,000 to $40,000
Over $40,000
# of Children (Ages 0 - 18)
*
Please Select
None
1
2
3
4
5
6
7
8
9
10
# of Adults (Ages 18 - 62)
*
Please Select
None
1
2
3
4
5
# of Seniors (Over age 62)
*
Please Select
None
1
2
3
4
Race/Ethnicity
*
African American
Hispanic / Latino
Caucasian
Asian
Prefer Not To Say
Other
Gender
*
Male
Female
Other
Signature
*
Submit Form
Submit Form
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