Needs - Special Request Form
Makaha Community Center/God Provides - Please list the items your family is in need of.  We will do our best to contact you if these items arrive on site.  Please make sure to give us correct contact info.  Although we cannot guarantee that we will have the items you are asking for, we will do our best to accommodate.  We will only wait a few hours from the time we contact you before contacting someone else due to the need to keep items moving off property.  We will also only allow a short window for the items to be picked up before going down the list to the next person.  Please be prompt in responding and picking up your items.  God bless you and thank God when  He provides for our needs.
Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Facebook Name (If you're in the  God Provides group)
Phone Contact # *
Address *
Need Beds?  Which Size?
Clear selection
Furniture
Clear selection
Appliance/Electronical Needs
Clear selection
These are the only items that we are creating a needs list for.  Please write any special instructions that might go with the items you requested above.  (For example:  How many of a particular item, any particular style or color, etc?)
Do any of these situations apply to you? *
Required
Would you be picking up or would you like us to contact someone to deliver for a fee?  ($35 delivery in Waianae per item and $5 more per extra item).  Outside of Waianae is $50 per first item and $5 more per extra item).  This is not a service that Makaha Community Center renders.  We are working with an outside source. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Makaha Community Center.

Does this form look suspicious? Report

Google Forms