First Name *

Last Name *

Email *

Cell Phone *

Enter Your Cell Phone Number Here

Date of Donation *

Donation Type *

If you assembled kits, how many did you donate? *

Total Volunteer Hours *

Each kit equals 1.5 hours.

Do you need documentation verifying your hours?

Yes

No

Do you have anything to comment regarding your donation?

If you need your letter sent to anyone else, please include their email address here.

Please Sign *

By signing this form, you understand that you are making an in-kind donation to Atlantic Outreach Group and agree that this information is accurate to the best of your knowledge.

Please upload a photo of your donation. Photo should be taken in front of the food pantry *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 2 Files )