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CAPC Food Box Give Away

The Child Abuse Prevention Council (CAPC)'s food boxes are now available at CFS in Antioch, at 4549 Delta Fair Blvd., in Antioch. Families must live in Antioch and have at least one child living with them. We still have a few boxes at the City of Antioch. Please choose the location in the last question. The food pick up includes enough food for a family of four for about 3 weeks. Please ask the family to arrive with extra space in a vehicle and someone who is able to help load the car.

To request a food pick up for the family you are supporting, please complete this google form and submit it. The form must be completed by a service provider (not a family member), but families will pick up the food. For questions or more information, please email Sofi Stanwood at sstanwood@capc-coco.org.

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Serice Provider Name
Requesting Agency
Service Provider Email
Service Provider Phone
Total Number of Children in Houshold
Primary Child's Name
Child's Birthdate
MM
/
DD
/
YYYY
Parent/Guardian's Name
Family's Address
City
Primary Language Spoken in the Home
Clear selection
Statement of Family Needs/Situation 
Does the family have a history of mental abuse?
Clear selection
Does the family have a history of substance abuse?
Clear selection
Have any children in the household been involved with Juvenile Justice Probation Services?
Clear selection
Location to pick up food box
Clear selection
Submit
Clear form
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This form was created inside of CAPC COCO. Report Abuse
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