Order Form - 😋 Youth Food Boxes 💝

😋 Youth Food Boxes 💝 - Order Form (cost-free)

Unfortunately we our completely out-of-stock of our Youth Food Boxes for 2025. For alternative food resources in the Linn, Benton, and Lincoln county region, please contact 211Info or the LBL Resource Database for more information (https://docs.google.com/spreadsheets/d/19pVcpMQWNesUQFa0RD8Rk5EOn5JJprn-18g-aD59xOA/edit?usp=sharing). If you are looking for a specialty food box with dietary accommodations (ARFID, vegan, gluten-free, etc.), please contact us at theteainlbl@youthera.org or 971-275-5450 as these food boxes are still available 🙂
Important: This is a temporary program until the end of 2025, with a limited number of Food Boxes to go around. We will do our utmost best to ensure all orders are fulfilled, and if for whatever reason we cannot fulfill your order, you will be notified promptly and provided alternative options to meet your needs 💗
☑️ Eligibility ☑️
Will the ordered Food Boxes be provided to young people 14-25 years old in Linn, Benton, or Lincoln counties?*
🦉 Basic Contact Information 🦉

Please be sure to make sure contact email and/or phone number you provide to us is correct, as we will use it to contact you and setup a delivery time for your Food Boxes
Contact Name*

First NameLast Name
Organization / Agency Name
If Applicable
Contact Email
example@example.com
Contact Phone Number
Please enter a valid phone number.
📦 Order Information 📦

Please ensure to share any dietary accommodations you or the young people you serve are in need of, we will do our best to meet those needs and communicate with you promptly if we are unable to meet a need
How many youth are in need of Food Boxes?*
1 Food Box per 1 Youth
Are there any requests regarding dietary accommodations? (Ex: peanut allergy, lactose intolerant, ARFID, etc.)
Do you have any questions you would like to be answered when we contact you about your order? Or is there any other information about your order you would like to share?
🗺️ Delivery Information 🗺️

Please provide the location of where the ordered Food Boxes are to be delivered to (if you are unhoused, please list an address of where you would like to meet to receive the boxes, or leave it blank and we'll coordinate it once we receive your order)
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
💓 Almost Done! 💓
Would you like to receive occasional emails from Youth Era on additional resources for young people?
Anything else you would like us to know? 🤔
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😋 Youth Food Boxes 💝 - Order Form (cost-free)

☑️ Eligibility ☑️

🦉 Basic Contact Information 🦉

📦 Order Information 📦

🗺️ Delivery Information 🗺️

💓 Almost Done! 💓