Relief Box
Please fill out the form to place your order for the relief box. We encourage those families who are in need to apply for the box. These relief boxes are for those who need it most, if you feel you are not in a dire situation please consider not applying. The goal is to help those families who are in need during this pandemic. The relief box will be dropped or can be picked up from a central location.  
The Relief Box Contains
1. Cereal
2. Flour
3. Rice
4. Canned Foods
5. Cooking Oil
6. Noodles
7. Snacks
Box items will depend on availability of items in stores.
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What is your name? *
What is your phone number? *
How many people are in your household? *
What is your house address? *
Do you have any dietary restrictions in your family?
I understand that I will be receiving a relief box as a donation and will not hold anyone liable from the risks that may be presented from grocery items, delivery, or curbside pickup. *
Required
Will you be able to pick up the relief box? *
Required
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