Channel One Food Shelf Registration
This form is for social workers, case managers or other professionals registering or checking in clients to pick up a food box on their behalf as a proxy. Eligibility information:
Email address *
Head of Household Name *
Head of Household Birth Date *
Address (Use ZIP CODE 55901 if homeless) *
Number of Adults (18 to 64) in household *
Number of Children (0-17) in household *
Number of Seniors (65+) in household *
Olmsted Connect Community Card number, or Channel One ID Card number, if known: *
The agency or organization you represent *
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