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.
Please select one
*
I will pick up the grocery bags from CARE Complex Facility.
I would like to have it delivered at my address.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you want to be considered for following items as well? (please select as applicable)
*
Bathroom Kits (included but not limited to towels, cleaning supplies, hygiene products, etc.)
Kitchen Kits (included but not limited to dishes, utensils, pots, pans, glassware)
Adult Diapers
Not Interested
Select your gender
*
Male
Female
Intersex
Date of Birth
*
 -
Month
 -
Day
Year
Date
What is your ethnicity?
*
White
African American
Asian
Hispanic or Latino
Native American
Other
Which primary language do you use?
*
Please Select
English
Spanish
German
Russian
Korean
Tagalog
Filipino
Arabic
French
Chinese
Hindi
Vietnamese
Portugese
Urdu
Others
Do you have insurance?
*
Yes
No
If yes, indicate the type.
Medicaid
Medicare
Private Insurance
Other
Name of the Insurance Proviver
Do you receive any additional forms of income or benefits?
*
Yes
No
If yes, check all that apply.
SNAP
SSI/SSDI
Unemployment Benefits
Disability Benefits
Child Support
Other
How many people are in your household?
*
Do you have children?
*
Yes
No
If yes, please please fill in the table below.
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Name
Age
Kid 1
Kid 2
Kid 3
Kid 4
Kid 5
Kid 6
Kid 7
Are you currently employed?
*
Yes
No
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)
*
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Job Position
Employer Name
Hours per week
Current Job
Last Job
I consent to receive SMS/text messages from CARE Complex regarding updates, programs, events, and other information relevant to the organization. Message frequency may vary. Message and data rates may apply.
*
I agree and give my consent to receive SMS/text messages from CARE Complex.
I consent to receive email communications from CARE Complex regarding updates, programs, events, volunteer opportunities, and other information relevant to the organization. I understand that I can unsubscribe at any time by clicking the unsubscribe link in any email.
*
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.
*
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