Save It Forward Food Pantry

Participant Guidelines

As a participant in the program,

1. I understand that it is my responsibility to notify the Program Director or the Community Pantry
Administrator in the event I am unable to attend the regularly scheduled distribution.
__________(Initials)
2. I understand that I will be removed from the program after the second time that I fail to show up
at the regularly scheduled distribution without prior notification to the Program Director or the
Community Pantry Administrator. __________(Initials)
3. I understand that it is my responsibility to keep up with distribution dates even if I do or do not
receive a reminder of the distribution. Distribution Calendars are available at every distribution.
___________(Initials)
4. I understand that I am required to return all recycle bags that I receive from the Save It Forward
Food Pantry Distribution at the next scheduled distribution. __________(Initials)
5. I agree to notify the School Counselor or the Program Director or the Community Pantry
Administrator in the event that my familys situation improves & I no longer require the
assistance of the Save It Forward Food Pantry. __________(Initials)
6. I understand that there are many families in need at my school and that I will forfeit my
opportunity to participate in the program if I fail to adhere to the guidelines set forth above.
__________(Initials)
7. Photographic Release: I grant and convey to Alive Ministries, Inc. all right, title and interests in
any and all photographs, images, video, or audio recordings of me or my likeness or voice made
by Alive Ministries, Inc. in connection to the services received from Alive Ministries, Inc.
__________(Initials)
The contact information for the Community Pantry Administrator for Barber Middle School is Petrina
Fowler 770-975-6764 ext. 274 or petrina.fowler@cobbk12.org and the Program Director is Rhonda
Smith - 678-232-9137 or Rhonda@aliveministriesinc.org.
I have read & understand the guidelines set forth above.
Signature______________________________________________________________________

Date_________________________________________________________________________