ClayHouse Meal Request

The ClayHouse Meal Ministry offers short-term support for our families in need. Due to this objective, we ask that a family not request meals more than three times per calendar year.

Name of person needing meals:

First NameLast Name

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Email:

example@example.com

Please select your need:

If you selected "Other" above, please explain:

Address where meal needs to be delivered:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many adults are in the household (please include yourself)?

How many children are in the household?

In the box below, please list up to three days/dates you would like to request dinner for (i.e. Monday, March 4). Please note that our goal is to provide meals on the dates listed, but we cannot make that guarantee until we have confirmed with our team. Should we need to recommend different dates, we will contact you right away.

The first date requested MUST be at least one week from today.

(NO HOLIDAYS, PLEASE)

Requested Meal Dates:

Please list any food preferences, aversions, or allergies (type in "none" if there aren't any):

Please list some preferred restaurants (in the event someone would like to send a gift card in lieu of a homemade meal):

What timeframe would you like your meal delivered?

Do you have any additional or special instructions?

Questions?

Name of person filling out this form, if different than above. If same, please type "same" in both boxes below.

First NameLast Name

If the person filling out this form is not the person in need, please add your Email and phone number so that we can contact you in case of questions.