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Canyon Care Center
Online request form for household/food items
Online ordering is confidential
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Student ID Number
*
Your answer
Student Email
*
Your answer
Delivery or pick-up
*
Delivery
Pickup
Food Allergies (put NA if no allergies)
*
Your answer
Number of household members
*
Your answer
Supplies
Shampoo/Conditioner
Soap/Body Wash
Toothpaste/toothbrush/mouthwash
Feminine Hygiene
Deodorant
Hand Sanitizer
Other
If "other" household supplies was selected above, what type of supplies would you like for us to try and supply?
Your answer
Food (choose all that apply)
Cereal
Soup
Pasta/Ramen/Mac and Cheese
Pasta Sauces
Hamburger-Tuna Helper
Canned Vegetables
Refried Beans
Peanut Butter and Jelly
Powdered Milk
Canned Pasta (spaghettios, chefboyrdee)
Canned tuna/chicken
Pancake/muffin mix
Other
If "other" food was selected above, please list the food(s) you would like for us to try and supply?
Your answer
Clothing-please indicate sizes needed
Your answer
Shoes-please indicate sizes needed
Your answer
Where there any items not listed above that you would like to see added to the care center?
Your answer
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