Sign up for a Christmas Basket (Schuyler County)
Please sign up to receive a Christmas Basket of food items.
Email address *
First Name *
Last Name *
I would like: *
Required
We have the following allergies in our household:
I will pick up my food basket at Schuyler Outreach on December 15:
Clear selection
I will pick up my food basket at Schuyler Outreach on December 17:
Clear selection
Family Size *
Is there something that you need help with right now? If so, please leave your phone number and a Staff Member will give you a call. You may also call us at 607-535-2050.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy