VOAD Covid-19 Food Response
During the Covid-19 situation, the Shasta/Tehama VOAD is coordinating a delivery system to get food to isolated seniors, those with disabilities, and the medically vulnerable within Shasta and Tehama County. If you need assistance completing this form please call 2-1-1 from any cell or landline in Shasta or Tehama County.

This temporary food service is being offered in response to those in our local community with no other food resupply options. This is the online form to submit a request for this food relief bag. This bag will contain a general non-specific collection of non-perishable, dry-good food items. No substitutions are available.

By completing this form you agree for the following contact information to be shared with all staff and volunteers involved with the Shasta/Tehama VOAD, in order to execute this emergency food response. By filling out this form you are also open to being contacted by staff and volunteers related to this distribution.
First Name (Nombre de Pila) *
Your answer
Last Name (Apellido) *
Your answer
Best Contact Phone Number (Mejor Número de Teléfono de Contacto) *
Your answer
Street Address (i.e. 7635 Sundial Bridge Drive) (Dirección Postal) *
Your answer
Apartment or Unit Number (When Needed) (Apartment o Número de Unidad, cuando sea necesario)
Your answer
City (Ciudad) *
Your answer
Year of Birth (Año de nacimiento)
Your answer
Number of People In Residence. (Numero de personas en residencia)
Select if you own a cat, a dog, or both (*pet food may or may not be available at the time of your delivery due to limited supplies) (Seleccione si es dueño de un gato, un perro o ambos, el alimento para mascotas puedo o no estar disponible en el momento de la entrega debido a suministros limitados)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy