Clone of October 28th Community Meal delivery

November 25th Community Meal delivery

Please note: meals will be delivered between 5:00pm and 7:00pm and the name, address and phone number must match WHO is receiving the meal.
Name

First NameLast Name
Address (Please provide physical address for driver)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City, State, Zip code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Please provide in case we need to contact you)
Please enter a valid phone number.Format: (000) 000-0000.
Email address to confirm your delivery request was received
example@example.com
How many meals are needed for your family?
Are you a Mill Township resident?
Do you or your family have any food allergies? Please list allergies below understanding that we may not be able to accommodate your request due to what will be served.
The next questions are simply for data purposes that will allow Thriving Grant County to continue applying for grants and funding our programs. Each question is optional, but helps our funders understand who we are serving. These questions will no affect you receiving meals or any service from Thriving Grant County. Thank you for answering to the best of your ability.
Would you typically have transportation to pick up your meal?
Please provide your age range.
Please provide your gender.
Please provide your race.
Please provide your ethnicity.
Please provide your gross income level for your family.
If there are children in your home, how many?
How many total people live in your household?
Should be Empty:

November 25th Community Meal delivery