Food Bank Registration Form
Fill in this form if you are in need of food relief. If you live, work or study in the Covent Garden, Holborn, Soho areas and are in need of food relief please get in touch. Many people who have never needed help before find themselves in need right now - in particular those working in the Arts, Theatre, Music and the Hospitality Industry. Covent Garden Community Centre & Dragon Hall Trust are here to help as much as we can. Fill in this form to access our Food Bank. We never know what is available but we will make every effort to get it sorted.
Email address *
Full Name *
Your answer
Address *
Your answer
Postcode *
Your answer
Phone Number *
Your answer
Borough of residence *
Your answer
Household Size (number of people needing assistance) *
Your answer
Please tick the box for size of parcel *
Required
Names of other household members and ages of children if included *
Your answer
Can you collect the food parcel by appointment?
If you can't collect please tell us why? We can help more people if it is possible for them to collect. We can arrange delivery if you are isolated, shielded or if health means you can't get out. *
Your answer
Do you have any allergies or dietary restrictions due to any health issue or cultural reasons? Let us know if you are vegetarian or vegan etc *
If yes, please tell us what the restriction is. *
Your answer
Reason for application *
Required
Do you need help with collecting medicine
Is a telephone befriending service of interest? We can organise someone to call and check in with you every couple of days
Who can we contact in an emergency?
Your answer
Apart from food are there any other products you are in need of? For example hygiene products, baby items, cleaning supplies?
Your answer
Which Centre is nearest your residence
How did you hear about the foodbank?
Submit
Never submit passwords through Google Forms.
This form was created inside of Covent Garden Dragon Hall Trust. Report Abuse