By checking this box the client acknowledges that they fall under one of the following low income categories:

o Receives government/income assistance or disability assistance
o Receives RAP benefits
o Falls within the Low Income Cut Off (LICO) Guidelines
o Senior's income assistance

It is important that you understand that food donations made from local stores are close to or past their “Best Before” date. This does not mean that the food is rotten or will make you sick. After you get the food from our program, it is your responsibility to keep any food items from going bad. For instance, meat should be frozen or cooked right away, dairy should be used as soon as possible, fruit/vegetables should be eaten right away or chopped/sliced and frozen, bread/buns can also easily be frozen. Also, if you and your family become sick with our food, you cannot ask our association to be legally responsible for that.

I acknowledge that the above information is true, and I understand and accept the content of this form.