BNDK PURPOSEFUL PLATES
Create a Family Support Page
Family Info of Recipient
Family Name of Recipient
*
Family / Individual
Phone Number of Recipient
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Their Story
Share what this family is going through and how support would help
*
Situation Type (Checkbox)
*
Oncology
Cardiac
Renal
Eating Disorder
Recovery / Life Event
Other
If selected "Other". Please explain
Upload Photo of Recipient/s
Does the recipient know they will be receiving meals
*
Please Select
Yes, they know
No, they don't know
No, Please reach out carefully
When should support begin?
*
-
Month
-
Day
Year
Monday is when meals are delivered weekly
Campaign Goal Amount
Recipient's Eating Program
Which is the HIGHEST PRIORITY, right now
*
Please Select
Benefits and Recovery
Taste Preference
Favorite Proteins
*
Chicken (Breast)
Chicken (Thighs, Legs)
Beef
Pork
Fish
Shrimp
Tofu
Beans
Eggs
Turkey
Other
Specify Other Options or Specifics (Example: Only eat Salmon/ Cod)
*
Favorite Cuisines
*
Italian
Mexican
Chinese
Indian
Mediterranean
American
Japanese
Thai
Middle Eastern
Vietnamese
Burgers & Hotdogs
Southern
Creole / Cajun
Caribbean
Soups / Chili
Chicken Strips and Fried Chicken
Salads
Grain Bowls
Chicken Salad (Avocado Mayo Based)
Sandwiches
Other
If selected "Other", please specify
Food Allergies
*
None
Dairy
Eggs
Fish
Shellfish
Peanuts
Tree Nuts
Soy
Wheat/Gluten
Other
If selected "Other", please specify
How many people are we feeding weekly? This will help us know what meal sizes to prepare each week.
*
Single Woman (1 serving/ Meal)
Single Man (2 servings/ Meal)
Family (Feed 3 - 4)
Family (Feed 5 - 8)
Other
If selected "Other", please specify
How many meals each week?
*
Individual (10 Meals)
Individual (15 Meals)
Individual (20 Meals)
2 Family Meals
4 Family Meals
6 Family Meals
Other
If selected "Other", please specify
*Weekly Delivery Schedule
Deliveries will arrive on Monday between 9am - 4pm.
Food will be cooked for the week and arrive on Monday for delivery. What will be the "Preferred" method of retrieving the meals each week, once delivered
Client will provide a cooler out front to place food inside
Client would prefer meals be placed in Garage Refrigerator
Client will have someone home at the time of drop off
other
If client prefer's Garage Refrigerator or Other, please provide further details. Upon approval a representative will contact the client if needing further assistance.
Your Info
Name
*
First Name
Last Name
Email
example@example.com
Submit
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