Pre-registration for Fruit and Vegetable Box

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This form is for those interested in preregistering for a fruit and vegetable box made possible by the Charles County Department of Health.

Due to the limited amount of boxes available, boxes are limited to one per family.

What date and location are you preregistering for?

P.D. Brown Library - 10 am 8/3/21 - 50 Village St, Waldorf, MD 20602

Department of Social Services - 10 am 8/26/21 - 200 Kent Ave, La Plata, MD 20646

Nanjemoy Community Center - 10 am 8/31/21 - 4375 Port Tobacco Rd, Nanjemoy, MD 20662

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Do you currently receive any of the following programs;

SNAP dollars

WIC Farmers’ Market Nutrition Program (WFMNP)

Seniors Farmers' Market Nutrition Program (SFMNP)

Temporary Cash Assistance

Other:

Will this event increase your access to fresh fruits and vegetables?

Yes

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Would you have purchased these items even if you were not given them for free?

Yes

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Are you confident that you can use all of these items to feed your family?

Yes

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Name

Email Address

Phone number

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