General Floating Food Support

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This can be self referral or by a professional
🥳We are limiting our deliver. Please pick up food Every Thursday 4pm - 5pm

Woodside memorial, SE25 (BUS 197)

If ill and elderly and can not pick up, please fill out this form with details of person in need Floating Counselling Community food. Please be aware we get surplus food from warehouses, to see extended dates of food certificate given please email or WhatsApp us.

Email *

Do you have a LINK to: Croydon, Lambeth or Southwark borough? (Live, Work, Education, Place of Worship) *

Yes

Please state which borough and what LINK? *

Ethnicity *

First Name (person in need) *

Last Name (person in need) *

Q1: Which of the following categories best describes why we need to deliver food? *

Sheilding / Ill / Vulnerable

Elderly

Parent of young children (under 5)

Other:

Q2: Mobile Number (person in need) *

Q3: Are you filling this form on behalf of another person *

Yes

Q4: If filling in on behalf of another, what is your details: (Full name, profession and company, Email and Mobile number)

Q5: What's your biggest struggle currently [what your client is struggling with if you are referring]?

Q6: Address (if you need your food package to be delivered)

Q7: What appeals to you most about this support / program? *

Q8: Do you have any allergies or have food preference ie: Vegetarian or Pescatarian, want baby food etc?

Q9. How many people in your household? *

Q10: We plan to gather feedback every 6 weeks of support. Do you agree to fill in the feedback form? *

Yes

Send me a copy of my responses.

Submit

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