Praise Tabernacle SDA Church
Food Pantry & Giveaway Program • 3710 James B White Hwy S, Whiteville, NC
Participant Sign-Up Form
Participant Information
First Name *
Last Name *
Phone Number *
Today's Date
Street Address
(optional)
Household Details
Number of Persons in Household *
Number of Children (under 18)
Program Participation
Is this your
first time
participating in our Food Pantry Program? *
Yes, this is my first time
No, I have participated before
⚠ Liability Waiver — Action Required
✓ Welcome back!
Since you have participated before, your Waiver and Release of Liability is already on file. No additional action is needed.
Please sign below and submit this form to a volunteer.
Action required before receiving food items:
All first-time participants must complete and sign our Waiver and Release of Liability. Please scan the QR code below with your phone camera, or visit the link to complete the waiver digitally — it only takes a few minutes.
Scan this QR code
with your phone camera
— or visit the link below —
https://3bgg0uj5.scispace.co/waiver.html
Complete the form and submit before receiving your food items.
I confirm that I have completed and submitted the Waiver and Release of Liability using the link or QR code above.
Participant Agreement
I certify that the information provided above is accurate and complete to the best of my knowledge. I understand that the Praise Tabernacle SDA Church Food Pantry provides assistance regardless of religious affiliation, race, or national origin. My information will be used for program records only and will not be shared with third parties. First-time participants confirm they have completed the required Waiver and Release of Liability.
Participant Signature
Date
Submit Registration
✓ Registration Submitted
Thank you,
!
Your sign-up for the Praise Tabernacle SDA Church Food Pantry Program has been recorded.
Please present this confirmation to a volunteer at the distribution table.