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2. Dear Pantry Participant:

   In an effort to continue to address food insecurity during this hectic time, Lenore's Pantry will be utilizing this shopping list form for all Registered Participants. Please complete the attached form and be sure to include all contact information so we can arrange food pick up. At the end of the form, there are blank lines for you to list any fresh fruits or vegetables that you would use to prepare your meals. We also ask that you include diaper size and formula preference for children in your home. We will complete the orders to the best of our ability. Email is the preferred method of submission for the completed forms (JBBadger@nattleboro.com). If that is not an option, please mail your form to: Board of Health, 43 South Washington Street, North Attleboro, MA 02760. We will be scheduling pickup times on Monday and Friday during our regular pantry hours. If you have questions or wish to register for pantry please call 508-699-0100 ext. 2520.

   Thank you and stay safe.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address*
16. Household Members (Number of Adults/ Number of Children)
18. Pickup Persons Phone Number*
20. Food Allergies / Diet Restrictions*
24. Cereal

    1. Toasted Oats
    2. Corn Flakes
    3. Instant Oatmeal
    4. Instant Quick Oats
    5. Instant Old Fashion
    6. Chex
    7. Shredded Wheat
    8. Cereal Bars
25. Canned Pasta

    1. SpaghettiOs
    2. Ravioli
    3. Beefaroni
26. Meat

    1. Hot dogs
    2. Canned Chicken
    3. Spam
    4. Hash
27. Tuna

    1. Yes
    2. No

    2 Cans

29. Chunky Soup

    1. Chicken
    2. Beef
    3. Clam Chowder
    4. Broth
    5. Other

    3 Cans

30. Condensed Soups

    1. Chicken Noodle (1)
    2. Chicken Noodle (2)
    3. Cream of Mushroom (1)
    4. Cream of Mushroom (2)
    5. Minestrone (1)
    6. Minestrone (2)
    7. Cream of Chicken (1)
    8. Cream of Chicken (2)
    9. Lentil (1)
    10. Lentil (2)
    11. Tomato (1)
    12. Tomato (2)

    Pick 5 (No more than 2 of one kind)

31. Pasta

    1. Spaghetti (1)
    2. Spaghetti (2)
    3. Spaghetti (3)
    4. Spaghetti (4)
    5. Elbow (1)
    6. Elbow (2)
    7. Elbow (3)
    8. Elbow (4)
    9. Ziti (1)
    10. Ziti (2)
    11. Ziti (3)
    12. Ziti (4)
    13. Other (1)
    14. Other (2)
    15. Other (3)
    16. Other (4)

    Choose 4

32. Baked Beans

    1. B&M
    2. Bush
    3. Vegetarian
    4. Chilli

    If available choose preference

34. Pasta Sauce

    1. Meat
    2. Meatless
    3. Alfredo

    1 Jar / Can If Available, Choice Preferred

35. Tomato Products

    1. Sauce
    2. Diced
    3. Stewed
    4. Paste
36. Raman Noodles

    1. Chicken (1)
    2. Chicken (2)
    3. Beef (1)
    4. Beef (2)
    5. Either
    6. Either (1)
    7. Either (2)

    2 Packages

37. Fruit

    1. Peaches
    2. Mandarin Oranges
    3. Pears
    4. Fruit Cocktail
    5. Pineapple
    6. Any

    1 Can

39. Crackers

    1. Yes
    2. No

    One Sleeve

40. Beverages

    1. Coffee Regular
    2. Coffee Decaff
    3. Tea Regular
    4. Tea Decaff
    5. Tea Flavored
    6. Hot Chocolate
    7. Juice
41. Peanut Butter and Jelly

    1. Yes
    2. No

    Families Only

42. Mac and Cheese

    1. Yes
    2. No
44. Vegetables

    1. Green Beans
    2. Peas
    3. Corn
    4. Potatoes
    5. Beets
    6. Carrots

    Two cans each. As available

45. Beans

    1. Red Kidney
    2. Chick Peas
    3. Black
    4. Pinto
    5. Cannellini (White)
    6. Dry Beans

    2 Cans, Select Preference

46. Snacks

    1. Pretzels
    2. Cookies
    3. Crackers

    If Available

47. Jell-O / Pudding

    1. Lemon
    2. Lime
    3. Orange
    4. Cherry
    5. Strawberry
    6. Vanilla
    7. Chocolate
    8. Butterscotch
49. Complete Pancake Mix

    1. Yes
    2. No
50. Maple Syrup

    1. Yes
    2. No
51. Dessert

    1. Brownie Mix
    2. Cake Mix
    3. Muffin Mix
52. Potatoes / Rice

    1. Mashed (1)
    2. Mashed (2)
    3. Mashed (3)
    4. Scalloped (1)
    5. Scalloped (2)
    6. Scalloped (3)
    7. White Rice (1)
    8. White Rice (2)
    9. White Rice (3)
    10. Noodle Mix (1)
    11. Noodle Mix (2)
    12. Noodle Mix (3)
    13. Rice A Roni (1)
    14. Rice A Roni (2)
    15. Rice A Roni (3)
    16. Stuffing Mix
54. Condiments

    1. Mayonnaise
    2. Mustard Yellow
    3. Mustard Brown
    4. Salad Dressing Ranch
    5. Salad Dressing Italian
    6. Ketchup
55. Personal Care

    1. Soap (Dial)
    2. Soap (Irish Spring)
    3. Soap (Dove)
    4. Shampoo
    5. Feminine Hygiene Products
    6. Mouth Wash
    7. Lip Balm
    8. Toothpaste
    9. Razors
56. Do You Have Dentures?

    1. Yes
    2. No
57. Do You Cook with Fresh Vegetables?

    1. Yes
    2. No
59. Wish List
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

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