Join Us as a Community Partner

Thank you for your interest in becoming a Table to Table community partner. We look forward to working with you soon!

Checklist

Complete application below & upload: 1.) Proof of nonprofit agency tax exempt 501(c)(3) status, 2.) a copy of your current satisfactory health inspection, and 3.) a copy of your food handling certification (if available)
Food/meals must be provided directly to individuals at no cost
Hours of operation compatible with Table to Table
Sufficient staff/volunteers to assist in receiving donations and properly distribute them to the community
Continual implementation of safe food handling practices to ensure participation in program

If you prefer, you can email the copies of your 501c3 and current satisfactory health inspection to: jkinner@tabletotable.org or mail them to: Table to Table 160 Pehle Avenue, Suite 303 | Saddle Brook, NJ 07663
Attention: Julie Kinner, Vice President of Operations

If you have any questions, please reach out to Julie Kinner at 201-681-0862.

Community Partner Application

Agency Application Form

Agency Name:(Required)

Agency Address:(Required)

Not for Profit:(Required)

Yes

501 (c) (3) Tax Status: Please attach below(Required)

Yes

Volunteers / Staff Available to Help with Delivery:(Required)

Yes

501 (c) (3) & Health Inspection Documents

Drop files here or

Max. file size: 50 MB.

Admin Contact:(Required)

First Last

Phone:(Required)

Email:(Required)

Type of Program(Required)

SHELTER

SENIOR PROGRAM

SOUP KITCHEN

FOOD PANTRY

AFTER SCHOOL

DAY CARE

OTHER

Major Demographic:(Required)

PRESCHOOL

ages 6-12

ages 12-21

men

women

seniors

other

Approximately, how many people do you feed monthly?(Required)

Delivery Address:(Required)

Delivery Instructions:(Required)

Staff Contact #1:

(available during deliveries)

Name:

First Last

Phone:

Email:

Days and Times available:

Staff Contact #2:

(available during deliveries)

Name:

First Last

Phone:

Email:

Days and Times available:

Staff Contact #3:

(available during deliveries)

Name:

First Last

Phone:

Email:

Days and Times available:

What days and time can you receive food?

Monday

Yes

Time

Tuesday

Yes

Time

Wednesday

Yes

Time

Thursday

Yes

Time

Friday

Yes

Time

Saturday

Yes

Time

Sunday

Yes

Time

Special Food Requirements:

Types of food you are unable to accept:

Available freezer space:

(write down the number)

Total #

Walk In

Stand Alone

Freezer Unit

Available Refrigerator space:

(write down the number)

Total #

Walk In

Stand Alone

Freezer Unit

Do you or does someone on your staff have Food Safety Certification?(Required)

Yes

Is your kitchen under the jurisdiction of the local health department?(Required)

Yes

Do you have a current Board of Health Certificate?(Required)

Yes

Are you willing to take a food safety handling class?(Required)

Yes

Do you agree to reasonable inspection of your facility for evaluation?(Required)

Yes

Will you agree to follow specified food handling guidelines?(Required)

Yes

Consent(Required)

I agree to the agency release form

Whereas, Donee has warranted to Table to Table, Inc. that all items received will be duly inspected by a qualified member of their
staff and found to be fit for human consumption, or they will not be accepted.
Therefore, Donee hereby warrants, represents and guarantees as follows:
1. That it has been awarded the status of 501 © (3) charity by the Internal Revenue Service.
2. The Donee will neither offer for sale, sell, trade, transfer or barter the items supplied by Table to Table, Inc.
in exchange for money, other properties or services from either recipients or other agencies. Nor shall a
“membership” fee or any other fee be required from recipients for receipt of donated food. If the Donee agency finds itself
with excess food received through Table to Table, Inc., Donee agency will contact Table to Table, Inc. for instructions for
distribution disposition.
3. That Table to Table, Inc., and the primary donor(s) have specifically disclaimed any guarantees, warrantees or
representations, expressed or implied, as to the purity or fitness for consumption of any or all such donated items.
4. That all items accepted are accepted in an “as is” condition.
5. That Donee will utilize employees or volunteers having sufficient training, expertise in evaluation, handling, preparation and
feeding of donating items to safely and properly judge, handle, prepare and feed.
6. The Donee, because of the qualifications of its personnel, as above specified, hereby accepts full responsibility for the
purity and fitness for human consumption of any and all items accepted.
7. The Donee will store and serve the product received in accordance with the recommendations of their local Board of
Health and/or other safe food handling guidelines as recommended by Table to Table, Inc.
8. The Donee hereby warrants and guarantees to Table to Table, Inc. and to the primary donor(s) that it will hold them
harmless of action, suits of law or in equity, or any obligation whatsoever, arising out of or attributed to any action.
9. The Donee will use the items related to its exempt purpose and solely for the feeding of people in need.
10. Donee agrees to abide by the policy of nondiscrimination in provisions of providing food for the specific needs stated in
Donee’s application. All donated products will be distributed in an equitable manner, following the established distribution
standards
11. Donee agrees to reasonable evaluation of its facility by representatives of Table to Table, Inc. to assure use of safe food
handling procedures and appropriate equipment and facilities for food received from Table to Table, Inc.
12. Donee understands that Table to Table, Inc. may terminate its donation distribution agreement immediately upon finding
a violation of this agreement immediately upon finding a violation of this agreement. Donee organization understands that
Table to Table, Inc. may take legal action required for recovery, through intentional misuse of donated product.
THE UNDERSIGNED HEREBY ATTESTS THAT HE/SHE IS A LEGALLY WARRANTED AND AUTHORIZED AGENT,
OF THE DONEE, WHOSE NAME APPEARS BELOW, AND BY HIS/HER SIGNATURE DOES HEREBY BIND IT TO THE
TERM, CONDITIONS AND LIMITATIONS OF THIS DOCUMENT OF RELEASE.

Digital Signature

Signature Required

Date(Required)

MM slash DD slash YYYY

Join Us as a Community Partner

Checklist

Community Partner Application

Agency Application Form

Staff Contact #1:

Staff Contact #2:

Staff Contact #3:

What days and time can you receive food?

Available freezer space:

Available Refrigerator space:

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