First Time Pre-Registration Food Recipient
Hello! We with Brazos Community Response Coalition (Brazos CRC) are so happy to serve you! Please complete the form below in order to help us expedite this process. The more people that pre-register, the more accurately we can plan and coordinate this food distribution. Please complete this form the first time you come to our little distribution. Once you have pre-registered and provided all of the information below, you can skip the details next week and complete this returning client form each week so we know to expect you!
https://forms.gle/gvNPQ94HeDsyfjmG9
Please know that we will not begin distributing prior to 4pm.
Please Enter Peace Lutheran Church from Airline Rd. Please do not block any entrances, driveways, roadways etc. Please remain in your vehicle and indicate if you what area of your vehicle you prefer us to place the items. This is contactless.
This information is collected to report back to the BVFB as a FNS and USDA requirement. We do not share any specific information to third parties and respect your privacy.
**If you are able to carpool and pick up for multiple families they also will need to have a household representative complete this form, and then email us at
brazoscrc@gmail.com
to let us know the name, phone number and vehicle description of the person picking up for them.
As a general policy Brazos CRC does not discriminate against anyone based on race, ethnicity, gender, sexual orientation, age, religion or occupation. All are welcome at the table.
We will not tolerate any hostility, rudeness to our volunteers or other recipients.
If you have any other questions, please email us at
brazoscrc@gmail.com
.
* Required
Email address
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zipcode
*
Your answer
Phone (that we can text to send important notices day of distribution)
*
Your answer
Will this be your first time to visit this distribution site?
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Yes
No
Are you below TEXCAP Income Guidelines
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Yes
No
Does the household receive foodstamps?
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Yes
No
How many individuals are in the household?
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Your answer
Ages 1. How many members of your household are 0-5 years old? .
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0
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10
Ages: How many members of your household are 6-12 years old? .
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0
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10
Ages: How many members of your household are 13-17 years old? .
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0
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9
10
Ages: How many members of your household are 18-40 years old? .
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0
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9
10
Ages: How many members of your household are 41-64 years old? .
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0
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8
9
10
Ages: How many members of your household are 65+ years old? .
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0
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9
10
Race: How many members of your household identify as Native American/Alaskan Native?
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0
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9
10
Race: How many members of your household identify as Asian?
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0
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9
10
Race: How many members of your household identify as African American?
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0
1
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10
Race: How many members of your household identify as Hispanic?
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0
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9
10
Race: How many members of your household identify as Caucasian?
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0
1
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9
10
Race: How many members of your household identify as Bi-Racial or other?
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0
1
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5
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9
10
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