CARE Complex Monthly Grocery Giveaway

CARE Complex Monthly Grocery Giveaway
Each bag could include a mix of items such as: Beverages, Instant meals, Baking goods, Rice & pasta, Chips, snacks, pretzels, crackers, Microwave meals, Spreads & sauces, Canned goods (variety)
👉 Please note:
- The bags are pre-packed and you will not be able to select individual items.
- Contents may vary from bag to bag.
- Distribution will be on a first come, first serve basis.
- Bags must be picked up from the CARE Complex facility.
- The scheduled pickup dates will be communicated to you directly once confirmed.
I will pick up the grocery bags from CARE Complex Facility.I would like to have it delivered at my address.
Delivery Radius Notice

Please note that home delivery is only available for addresses within a 5-mile radius of CARE Complex (ZIP Code 89101).

Clients whose addresses fall outside this radius will not qualify for delivery and will need to pick up their items directly from the CARE Complex facility.

ZIP Addresses with delivery option available:
89101 (Downtown/City Center)
89102 (Central West/Chinatown area)
89104 (Central East/Commercial Center)
89106 (West of 89101/Historic Westside)
89107 (West of 89101/Twin Lakes)
89108 (Northwest of 89101)
89109 (North Strip)
89110 (Northeast of 89101)
89115 (Northeast - Nellis AFB area)
89119 (South of 89101/Airport area)
89121 (Southeast of 89101)
89030 (North Las Vegas)
89031 (North Las Vegas)
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MaleFemaleIntersex
Date of Birth*

MonthDayYear
Date
WhiteAfrican AmericanAsianHispanic or LatinoNative AmericanOther
Which primary language do you use? *
YesNo
MedicaidMedicarePrivate InsuranceOther
Name of the Insurance Proviver
YesNo
SNAPSSI/SSDIUnemployment BenefitsDisability BenefitsChild SupportOther
How many people are in your household?*
YesNo

If yes, please please fill in the table below.

Rows	Name	Age
Kid 1
Kid 2
Kid 3
Kid 4
Kid 5
Kid 6
Kid 7

YesNo
If unemployed, how long have you been unemployed for? (in months)

Please fill in the following employment history. (If unemployed write the most recent job)*

Rows	Job Position	Employer Name	Hours per week
Current Job
Last Job

I agree and give my consent to receive SMS/text messages from CARE Complex.
I agree to receive email updates from CARE Complex.
I understand that grocery bags are distributed on a first come, first serve basis, that contents may vary, and I cannot select individual items. I confirm my interest and agree to pick up my bag at CARE Complex on the communicated dates.*
Should be Empty: