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DC Dine11.org Hospital Partner Sign Up Form
Please complete this form to participate as a Hospital Partner in Dine11 - Washington D.C.
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* Required
Name Of Hospital
*
Your answer
Primary Address
*
Your answer
Primary Contact
*
Your answer
Primary Phone Number
*
Your answer
Primary Email
*
Your answer
Drop Off Location
*
OUR DRIVERS NEED TO KNOW LOCATION & SPECIFIC DIRECTIONS FOR ALL DROP OFFS
Your answer
Number To Be Called Upon Drop-Off
*
OUR DRIVERS ARE INSTRUCTED TO STAY OUTSIDE DURING THE DROP-OFF PROCESS
Your answer
Lunch Shift - Head Count
*
Your answer
Lunch Shift - Time
*
Time
:
AM
PM
DInner Shift - Head Count
*
Your answer
DInner Shift - Time
*
Time
:
AM
PM
Best Delivery Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
Urgent dietary restrictions - If any
Your answer
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