Emergency Food

If you need food between pantry days, you may request emergency food.

A person/family must come to, or have someone pick up for them during, a regular pantry day to get an emergency fill between pantry days. A person/family may receive an emergency fill one time per month. A person/family may only receive an emergency fill three times in a row before having to come back to a regular pantry day or have someone pick it up during a regular pantry day.

Please either fill out this form or use the contact information listed below and someone will contact you to arrange a time.

Call Brookside church between 8:00 a.m. and 5:00 p.m. Monday - Friday.

Brookside Church: (219) 866-5860

Name

First Name

Last Name

Phone

Please give us a phone number (including area code) where we can reach you to set up a pick-up time.

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Total Number of Family Members

How many people are in your family?

Number of Kids

How many kids (ages 0-18) are in the household?

Number of Adults under 65 years old

How many adults in the household are under 65 years old?

Number of Adults 65 or older

How many adults in the household are 65 years old or older?

Birthdays

Please tell us if any of your household members have birthdays this month. Please tell us the date and gender of the person with the birthday.

Allergies

Please list any food allergies, that any of your household members may have.

Message

Please add any questions or comments you may have about the food pantry or this emergency food fill.