COVID-19: Grocery Delivery Request
Christ Place Church understands there are many people being quarantined at home and are unable, or do not feel safe, going out to get groceries. We want to be a resource!

This simple request form asks for your contact information and your general grocery needs. Once the request is submitted, you will be matched with a volunteer shopper/deliverer who will contact you to confirm details for your request and next steps.

We understand this is a unique time for many, and we do not want anyone to feel like they need to compromise their own health (or others) in order to get to the store for groceries. Before you submit your request, here are a few things that we would like you to know:

1. We anticipate being able to offer this service to anyone who contacts us; however, we are volunteer ran, so we may be unable to meet all needs. You will receive a follow up phone call to confirm if your request can be met.

2. The contact information that you share with us, will be shared with a volunteer on our team.

3. It may take at least 24 hours before you hear a response for your request.

4. It may take several days to fulfill your request, so please fill out the form at least a 2-3 days before you are out of groceries.

5. This request form is for shopping/delivery with the expectation that you will pay for the cost of the groceries. (The shopping and delivery is free!) If you would like to request financial assistance for groceries, please indicate that on this form when it asks how you intend to pay for the groceries.

6. We encourage grocery orders to be $150 or less. If your grocery needs are higher, please discuss this with your volunteer shopper.

We are thankful we get to connect with you to help meet this need, and our goal is to make this process as simple and efficient as possible. If you have any questions, please do not hesitate to contact Ashley Woodman at

Email address *
Contact Information
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Preferred Mode of Communication *
Are you currently sick or potentially have COVID-19? *
Are you currently quarantined because of potential exposure to someone with COVID-19? *
Have you traveled by plane since March 6, 2020? *
Are you able to personally receive deliveries? *
Home or Delivery Address *
Street, City, State, Zip Code
Your answer
Age *
Your answer
What day do you need your delivery? *
We will try and make the delivery as soon as possible, or at least by the date you request.
How do you intend to pay for the groceries? *
How much do you expect your grocery request to cost? *
We may not be able to complete orders more than $150.
Do you have a preferred grocery store? *
Your shopper will only be shopping at one location, and will try their best to shop at your preferred location.
Your answer
Now to the grocery list! Please list your needed items below. *
As you list items, please be as specific as possible to include desired brand, quantity, size, flavor, dietary restrictions, etc. If you are not specific, or the store does not carry your specified item, the shopper will purchase the smallest quantity, the lowest price and the mildest of flavor of requested item.
Your answer
Are there any other details you would like us to know about your order? *
Your answer
How did you hear about Christ Place Grocery Delivery?
Your answer
How can we be praying for you?
Your answer
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