LA County Grant Meal Program Reservation Form
The Topanga Community Center is working in partnership with LA County Supervisor Sheila Kuehl’s office to distribute meals to Topanga Canyon residents who have been adversely affected by COVID-19.
This form will be kept confidential: Please complete as much of this form as you feel comfortable. The information will only be used to plan for meal preparation and grant reporting.
Meals will be brought to the Topanga Library parking lot area for pickup. Meals can be picked up for individuals who are homebound, as long as that person's name is listed below.
All individuals who sign up will be provided a meal. Additional meals will be on hand for those who have yet to sign up, but supplies are limited.
Name of participant (first name at least)
Phone number of participant
Will you be picking up for yourself?
No, I will add the name of the person(s) who will pick up the meal for me below.
Please list any person(s) designated to pick up your meal(s):
How will you be picking up your meal(s)?
How many meals do you need for your household? (Number)
Which days would you like to pick up your meal(s)?
Preferred pickup time (15 min increments after 3:30pm)
Do you have any additional information you would like to share? Do you know of someone who needs a meal & who we should reach out to? Please provide a way to contact that person.
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This form was created inside of Topanga Community Club.