Mother Teresa Community COVID 19 Response
Food Hamper Delivery Request Form (Non-Perishables and Grains Only)
Are you allergic to any food items?
If you said 'Yes' to the above say what you are allergic to?
Choose a food kit that is appropriate to your need
Kit with Hot and Spicy Food Items
Food Kit with Snacks for School Age Children
Food Kit without Hot and Spicy Items
Complete Address with Zip Code Address (Within Calgary and area Only)
Which one of the following best describes your current situation?
New Immigrant (Arrived in Canada in less than six months)
I have 2 or more children of school age
Self Isolated and low immune
Temporary Foreign Worker
Would you like to be contacted for any feedback or surveys in the future?
Will you require food support from us in the future?
Delivery/Pick Up Options:
I will come and pick up the food items after someone contacts me from the church
I would like to have food items delivered to my address given above
Please let someone I authorize to pick up food items on my behalf
Send me a copy of my responses.
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