2022 Pesach Package Registration
It's that time of year again!  If you will be home for Pesach, please use the form below to register for a package.  

If you know of someone who could use assistance to make Pesach, please contact Ruth at ccc@jfsa-cleveland.org with their information and we will reach out to them.

The deadline for registration is February 1st.  Chag kasher v'sameach - Wish you a Happy Passover.
Sign in to Google to save your progress. Learn more
Email *
Last Name *
First Name *
Phone Number *
Cell Phone Number
Would you like to receive text reminders regarding package pickup? *
What is your zip code? *
Did you receive a Pesach Package from the Chesed Center last year? *
How did you find out about our Pesach Packages? *
Required
Are you eligible for Kemach? *
Does your family receive income-based government assistance such as SNAP, Medicaid, WIC, etc? *
Please check any that apply: *
Required
I will be home for: *
Number of family members LIVING AT HOME *
Age range of CHILDREN living at home and/or unmarried children who will be with you for Yom Tov (check all that apply) *
Required
Number of married children joining you for Yom Tov *
In the space below, please provide any additional information we might need to know.
Are you in need of further assistance?
We are here for you year-round, providing groceries and other necessities.  If you are in need of assistance beyond Passover, please fill out our New Client Intake Form here: https://clevelandchesedcenter.org/client-resources or contact our office at 216-932-3115.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms