CARE Center Intake Form

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CARE Center Intake Form

CARE Center provides food assistance to the Northeast Texas Community College students, family, and staff who are in need. CARE Center is a FREE campus resource for any current NTCC student. Each student can access our pantry once a month. Just present your current student ID. If you or someone you know could use this service, please contact us at 903-434-8307 or at CARE@ntcc.edu.

Please complete the information below:

Name:

Student ID:

Email Address:

Phone:

County:

Services Requested:

Food Pantry/Hygiene

Cook Nook

Wellness

Mentor

Event/Activity

Number of people in household:

Number of children in household (under the age of 18)

Liability Release and Waiver

The undersigned client certifies that the information/answers provided above are complete and true. You further agree to the following:

(Please read carefully. Any questions you may have can be directed to a food pantry staff member.)

You understand that this food pantry aids NTCC students, family, and staff who are in need once a month or determined as needed.
Food is provided on a FIRST COME, FIRST SERVED bases and I relinquish NTCC and the NTCC Food Pantry of all liability of any nature whatsoever and accept the food "AS IS" and at my own risk.
There is no guarantee to the amount or type of food product given and there will be no substitutions made.
You will not sell the food or non-food products or exchange/barter food or non-food products for services.
Inappropriate behavior such as profanity, verbal abuse of staff, or any other disruptive behavior is prohibited. Any such behavior may result in the suspension or termination of your privileges at this pantry.
The party participating will not hold NTCC CARE Center or its volunteers responsible for any personal injury, death, or loss of property.

Acceptance of Free Food and Waiver of Liability

By my signature I acknowledge receipt of free food from NTCC CARE Center Pantry. I further understand and agree that by accepting this donated food I freely and voluntarily, with full knowledge, hold harmless and in no way liable or responsible for the quality, condition, or packaging of the food. NTCC, its officers, agents, employees, students, volunteers, and food suppliers.

I confirm that I have read, consent, and agree to the Eagle Pantry Liability Release and Waiver, and Acceptance of Free Food and Waiver of Liability

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