Consent

To become a client of Voedselbank Houten, please complete this form. By doing so, you will enter into a client agreement with us. We will ensure, until the food assistance stops, that you can come and collect food from the food bank every week. You keep your appointments with our volunteers and collect your parcel every week or cancel if you are unable to come on one occasion.

We have asked, or will ask, for some information from you. Without these details, we cannot process your application:

Your
- full name, date of birth and gender, whether you are married,
- address details , your phone number and email address,
- name and dates of birth of live-in housemates and children,
- financial information of your household
- details of your diet (halal, vegetarian, sugar-free, etc.)

Why do we need this? We use the data to invite you for appointments, to track appointments and whether you have come to collect your parcel. When your food packaged needs to be delivered we use your address. We need the financial documents to assess your eligibility for a food parcel according to national guidelines. This includes information about your income, expenses, debts and payment arrangements.
Your details go into a secure client registration system. Only the people who really need your data can access it. We will never give your data to people outside the food bank without your permission. You can always withdraw permission.

If you have caregivers or companions who help you

Sometimes it is helpful if we can contact people involved in your finances directly. This might include administrators, debt counsellors or tutors. You can give us permission on this form but this is not compulsory. If you do not give permission, you must send or arrange for us to see the information we need yourself.

Please fill it in as completely as possible:

body: contact: Phone number: e-mailadress: type of body: Explanation:

body: contact: Phone number: e-mailadress: type of body: Explanation:

body: contact: Phone number: e-mailadress: type of body: Explanation:

body: contact: Phone number: e-mailadress: type of body: Explanation:

Do you give permission to the Voedselbank Houten to contact these bodies to request information regarding my finances? You can withdraw your consent at any time.
YesNo

If you have children

We have an alliance with “Stichting Jarige Job”. This foundation provides a birthdaybox for children up to 18 years old. It contains presents, decorations for the home and treats for school. The contents of each box are different and fits your childs age. We do need to provide the name, date of birth and gender to Stichting Jarige Job to order the box. We do need to provide the name, date of birth and gender to Stichting Jarige Job to order the box. The box will then be ready for you in the week before your child's birthday.

Do you give permission to Voedselbank Houten to pass on the above details of my children to Stichting Jarige Job to be able to order a birthday box.
YesNo

Signing

Your Name

Uw date of birth

Your e-mailadress

You will receive a copy of this form via email.

You can change your consent at any time by completing this consent form again or emailing it to aanvraag@voedselbankhouten.nl.

Voedselbank Houten respects the privacy of the applicant and the data provided by him/her. The Voedselbank Houten does not make the recorded data available or available for inspection to third parties, unless legally obliged to do so.
The data are used solely for the purpose of and in accordance with the realisation of the objectives of the Voedselbank Houten. You can always request, withdraw or change your consent.
With the above arrangements, the Voedselbank Houten complies with law "Algemene Verordening Gegevensbescherming (AVG)". You can read more about this on our website in the privacy verklaring .