Foodshop Register – Sutton Community Works

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Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Address*

Street Address Address Line 2 County / State / Region Post Code

Date of birth

YYYY

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Have you been referred by the foodbank?-HIDDEN

Yes

Who referred you?*

Foodbank

Sutton Housing Partnership

Sutton Citizens Advice Bureau

Council Welfare Team

Encompass

Other

The following information will enable us to support you and signpost for additional help where appropriate:

Are you a lone parent?

Yes

Is English your first language?

Yes

If no please state your first language:

Do you ever struggle to pay?

Rent

Energy Bills

Other

Other:

Have you had to cut back on the amount you spend on shopping in the last 3 months?

Yes

Do you ever run out of money at the end of the week/month?

Yes

How many people are in your household?

Adults

Please enter a number from 1 to 10.

Children

Please enter a number from 0 to 10.

Are you interested in information about:

Housing Advice

Benefit Advice

Energy Bills

Money/Debt Advice

Health and Wellbeing

Training/Employment Skills

Cookery Skills

Other

What is your current living situation?

Sutton Council

Private Rent

Housing Association

Owner Occupier

Lodger

Other

What is your current employment situation?

Working Full-Time

Working Part-Time

Job Seeking

Retired

Other

Do you have a partner?

Yes

Does he/she work?

Yes - Full Time

Yes - Part Time

If yes, please state their occupation:

Do you have a long-term health condition?

Yes

If yes, please state your long-term health conditions:

Weekly Foodshop

Price:

What works for you?*

Weekly

Monthly

Payment Method:*

PayPal (Debit or Credit Card)

GoCardless (Direct Debit)

Cash (In-store)

We sometimes take photos during our workshops/sessions/activities. We use these photos to promote our services and the activities we offer. We may also use the photos for displays and to showcase our work on social media (Facebook and Twitter). Occasionally we also use the photos we take for external events, flyers and advertising brochures. We never publish names with the photos.

I give my permission for photographs to be used for internal displays

Yes

I give my permission for photographs to be used for displays

Yes

I give my permission for photographs to be used on Sutton Community Work’s social media (Facebook and Twitter) and website

Yes

Consent*

I agree to the privacy policy and in submitting this form I confirm that what I have submitted is correct. I understand that the information given for this form will be used for:

- Processing my registration details to gain access to the Community Food Shop
- Shared with our partner organisations for the purposes of administration, careers guidance, training, monitoring and any other support required
- Monitoring the effectiveness of our projects, activities, services and policies.

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Food Shop Registration

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