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Eat Home Yolo Delivery Registration
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First Name *
Last Name *
Phone Number *
Phone type *
Address *
City *
Zip Code *
Any special delivery instructions?
Number of residents in the household *
Is the recipient low income? *
Age *
Is the recipient disabled? *
Does the recipient have access to a vehicle they can drive? *
Does the recipient have a family member, neighbor, or friend who can pick up food for them? *
Is there any additional information the recipient would like to notify the food bank of?
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