Palm Beach County Food Bank Sign-In Sheet
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1 FOOD PANTRY
SOUP KITCHEN
RESIDENTIAL
Palm Beach County Food Bank
SIGN-IN SHEET
DISTRIBUTION DATE:
AGENCY NAME/NUMBER:_____________________________________________
One person per family must print their name and fill in the number of people in their household or total number of meals
they are receiving. The total should not include the person signing in.
# of People in
# of People in
Name:
Name:
Household/Meals:
Household/Meals:
1.
17.
2.
18.
3.
19.
4.
20.
5.
21.
6.
22.
7.
23.
8.
24.
9.
25.
10.
26.
11.
27.
12.
28.
13.
29.
14.
30.
15.
31.
16.
32.
TOTAL # OF NAMES: ______ TOTAL # OF PEOPLE IN HOUSEHOLD/MEALS: _______
Food provided by the Palm Beach County Food Bank (PBCFB) is intended for Palm Beach County residents.
NOTE:
PBCFB agrees to uphold and maintain the confidentiality of the information supplied by your agency which includes but
is not limited to, client lists of information.
Last updated: 12/5/2016
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