Immanuel Community Services Food Bank Delivery - COVID-19 Support
If you are unable to come to our weekly food bank due to COVID-19, we are offering food deliveries to ensure everyone gets what they need during this time.

The arrival of your first bag of groceries can take up to one week after you complete this form. Food delivery will continue each week until you cancel or we notify you otherwise.

What you receive in your delivery bag is subject to availability each week. We cannot guarantee certain types of food each week. We will do our best to accommodate allergies noted.

We generally have food in the following categories:
Canned goods, dry goods, dairy, prepared foods, produce, bakery

UPON COMPLETION OF THIS FORM, YOU AGREE:

- You will not come to the food bank to shop for food since you receiving home delivery

- You will maintain a 6ft distance from volunteers dropping off your food

- You will email foodbank@icsseattle.org for requests, questions, concerns about your food delivery. You may also call 206.622.1930
First Name *
Your answer
Last Name *
Your answer
Date of Birth
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Building name and unit # (if applicable)
Your answer
Any special instructions to access your front door?
Your answer
Email
Your answer
Phone number *
Your answer
Gender
How many people in your household? *
Your answer
Check all ages that apply to people in your household *
Required
Ethnicity: Check all that apply to people in your household
Is anyone in your household a veteran? *
Please list any food allergies/sensitivities in your household
Your answer
Any general requests for groceries? Again, we cannot guarantee anything as all of our food is donated.
Your answer
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