The Florrie Food Union COVID-19 Contact Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Leave your details and let us know how The Florrie can support you during the COVID-19 pandemic.

Unfortunately we can only support L8 residents at this time but we can put you in touch with other support organisations in your area if you need extra support.

Full Name *

Age *

Address *

Postcode *

Contact number *

Have you engaged with The Florrie before? *

Yes

Maybe

How many people are in your household & what are their ages? *

Please tell us how we can support you (In regards to food deliveries please include any allergy details). *

I agree to being contacted by The Florence Institute Trust

Yes

Clear selection

I agree that in order to receive the help I have requested my details may have to be shared with trusted Florrie partners (volunteer drivers, other charities & legal aid act).

Yes

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.