Safe Food Fridge Interest Form

Thank you so much for your interest in getting a Safe Food Fridge or adding a community request whiteboard!

Completing this form is simply a way to express interest and check site viability. It is not a binding commitment.

Autistics for Safe Food is an initiative of Autistic Pride Chattanooga, a registered 501(c)(3) nonprofit organization. What sets our spaces apart from traditional blessing boxes or food banks is our interactive request board, where community members can write down specific needs to honor the true dignity of food choice. We then work to distribute and fulfill those requests through our network and partner organizations. Please note that hosts are never expected or asked to fill these requests themselves.

Take a moment to fill out the details below about your proposed location. Once you submit, our Autistics for Safe Food ambassador will review your info and reach out to follow up with you.

Name & Pronouns

NamePronouns

Name of Organization (if applicable)

Name of Organization

Proposed Fridge/Community Request Board Location?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary contact for the fridge/community request board

example@example.com

Primary contact for the fridge/community request board

Please enter a valid phone number.Format: (000) 000-0000.

Do you already have a fridge to use for this site?

Photo of the proposed spot (a wide shot of the area)

Photo of the proposed spot (a close-up of the ground/surface)

Photo of the area where the community requests board will be located

Is there a flat, concrete slab or solid, level foundation available for the fridge?

Other

Is there existing overhead weather protection for the fridge?

Other

Is there a reliable outdoor electrical source available on-site?

Other

Is the location easily and safely accessible to the public 24/7 with a clear, level path?

Other

Additional location details