MOWGSC Spokane Fire Response - Clients

As wildfires continue to impact our community, we're checking in with clients to ensure everyone is safe and to help us continue delivering meals as reliably as possible.

Please complete this short form or have a family member or caregiver complete it on your behalf.

PLEASE NOTE THAT IF YOU ARE CURRENTLY LOCATED IN A LEVEL 3 EVACUATION ZONE WE WILL NOT BE ABLE TO DELIVER TO YOU.
Sign in to Google to save your progress. Learn more
Home Address *
Best phone number to reach you *
Full Name *
Has your household been impacted by the Autumn, Old Trails, or Fairview fires? *
Required
Are you currently staying at your normal delivery address?
Please note that if you are located in a Level 3 (Go Now) evacuation MOWGSC will NOT be able to deliver to you *
Required
If no to the above, what if your current address or location?
Do you have enough food if deliveries are delayed because of the fires? *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Greater Spokane County Meals on Wheels.

Does this form look suspicious? Report

Google Forms