Registration – Droitwich Community Pantry

Registration Form

Email Address *

Confirm Email *

User Password *

Confirm Password *

First Name *

Last Name *

Address Line 1 *

Address Line 2

Town / City *

Post Code *

Phone Number *

Number of ADULTS in the household *

Number of CHILDREN aged 0-4 *

Number of CHILDREN aged 5-11 *

Number of CHILDREN aged 12-16 *

Dietary Requirements

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Membership Number

I have read and agree to the terms and conditions set out in the Privacy Policy and Terms of Use Policy *