Emergency Food Delivery Order from Active Faith on 4/1/2020
Delivery is limited to those homebound by medical necessity, those over the age of 60, or those with immunocompromised family members. If you are able to pick up from Active Faith, please use our form labeled "Emergency Food Pick Up Order from Active Faith"
Please complete this form by 3/30/2020 at 3:00 p.m.
In the interest in maintaining social distancing and following the recommendations of the CDC: the delivery personnel will place the items on your porch on 4/1/2020, and knock/ring the bell and leave. The delivery person will not/cannot enter the home.
Email address *
First and Last Name *
Your answer
Complete Address including zipcode *
Your answer
Phone number *
Your answer
Number of Adults in the Household (18+) *
Your answer
Number of Children in the Household (under 18) *
Your answer
Are you a current Active Faith client? (For bookkeeping purposes only, does not affect eligibility to receive emergency food assistance) *
The following is a list of items we could possibly have in the food pantry. Please check the items that you are in need of today. We will do our very best to provide what you need if it is available. *
Required
Please indicate choice of Frozen meat and Fresh Produce. We will do our best to provide it if it is available.
Your answer
Are you in need of personal hygiene products? (please specify which items you need, we will provide if we can)
Your answer
Please list any food allergies/sensitivities or any other comments. (Food allergy considerations will be accommodated when possible, but the responsibility to check packaging in on the family receiving the food)
Your answer
Please read the following disclosure statement, by submitting this form you agree to the conditions listed. This service is for those who are over 60, immunocompromised , by medical necessity or lack transportation.
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