Baptist Center Food Pantry and Clothes Closet Assist Request

The South Yadkin Baptist Association has a Food Pantry and Clothes Closet at the Baptist Center located on Amity Hill Road in Statesville.  If you want to refer a family for assistance, please complete this form.  I will contact them to schedule an appointment.

Mary Jane Hoover
South Yadkin Baptist Association
Ministry Assistant
704 873-4372, ext. 3
Fax: 704 873-1930
mhoover@sybaptist.org

Your Name (required)

Your Email (required)

Your Phone Number (required)

Your Church or Organization (required)

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Client Name (required)

Client Address (required)

Client Phone Number (required)

Client Alternate Phone Number

Total Number in Family (required)

Total Adults in Family (required)

Total Children in Family (required)

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Please fill out the following information for each member of the household:

Name #1

Relationship to Client

Date of Birth

Gender
 male female

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Name #2

Relationship to Client

Date of Birth

Gender
 male female

__________________________________

Name #3

Relationship to Client

Date of Birth

Gender
 male female

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Name #4

Relationship to Client

Date of Birth

Gender
 male female

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Name #5

Relationship to Client

Date of Birth

Gender
 male female

__________________________________

Name #6

Relationship to Client

Date of Birth

Gender
 male female

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Name #7

Relationship to Client

Date of Birth

Gender
 male female

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