Community Food Drive Support Request Form
During the ongoing government shutdown, Therapeutic Relations is committed to supporting individuals with developmental disabilities, as well as their families and caregivers in the community. This form allows households to request food assistance and essential items through our Food Drive Support Program During this challenging time, Therapeutic Relations is committed to standing beside our community. We understand that the government shutdown has placed unexpected strain on individuals with developmental disabilities, their families, and many households who rely on consistent resources. Our food drive is designed to help bridge that gap and ensure no one goes without essential support. Please complete the form below so we can better understand how to assist you and your family. *Donations can be picked up at our location 5273 Broadview Rd. Parma, Ohio 44134 at the day and time requested when contacted. Please fill out contact information as best as possible so we can assist you! At Therapeutic, WE CARE!!
Full Name
*
First Name
Last Name
Is this form being completed by the individual or someone on their behalf?
Individual
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Person(s) affected by shutdown (government employee)
Other
Address
*
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Street Address Line 2
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Email
example@example.com
Contact Information
*
Please enter a valid phone number.
Best way to contact you
Phone
Text
Email
Household Size
*
Number Individuals with Developmental Disabilities in Household
*
Type of Support Requested
*
Please Select
Food
Supplies
Food & Supplies
Other
I understand donations will be picked up at the location once day and time has been confirmed at 5273 Broadview Rd. Parma, Ohio 44134 (availability based on volunteer capacity)
Yes
No
Delivery requested (priority given to those households without transportation)
Additional Notes
Submit
Should be Empty: