I need assistance
Feedmont is offering a matching service between individuals who are in need and those who are low-risk.
For the purposes of this form, individuals who are considered high-risk include those who are 60 years of age and older, people who are immunocompromised and/or people who are experiencing economic hardship or any other group that cannot fulfill these needs themselves without putting themselves or others at risk.
Once a match is made, you and your match can coordinate the delivery of essential supplies, like food, toiletries, and prescriptions. Please follow all directions provided by the CDC to mitigate community spread.
We will match you with someone as soon as a volunteer becomes available!
Preferred method of communication
Preferred grocery store
I have no preference
I would like to receive groceries...
One time only
Preferred method of payment
How did you hear about Feedmont?
Social media (Instagram, Facebook, etc.)
Word of mouth
Questions or Comments
By selecting "I agree" below, I agree that I would like to be contacted by Feedmont to receive a match and/or be contacted by my match directly. My contact information will be given to the volunteer. I understand that I am not guaranteed a match, but Feedmont will try their best to do so. I accept all risk and responsibility and further hold any facilitator associated with Feedmont harmless
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service