Rainbow Meal Order Form

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In keeping with our mission to help improve the lives of older LGBT people, we are continuing this free meal effort with the help of Picnk for an indefinite period of time. During these difficult times, Rainbow Elder Care will be offering FREE meals to those age 60 and older who are in need because of the coronavirus emergency. If you are in need, age 60 or older, and live within about a 30-mile radius of Dayton, please review the meal options below for the menu and place your order for a maximum of three (3) meals plus two snacks per week BY 6 PM EACH FRIDAY to be prepared for DELIVERY THE FOLLOWING TUESDAY BETWEEN 2 - 6 PM. If you can't be at home to accept the meals, they will be left for you in a cooler bag. If you have questions, please contact us at lgbteldercare@yahoo.com or 937-623-7024.

Name of Person Requiring Meal *

Birthdate of Person Requiring Meal *

YYYY

Best Phone Number (mobile number preferred) *

Best Email Contact *

Street Address Where Meals Are To Be Delivered *

City *

Zip Code Where Meals Are To Be Delivered *

Please list any food allergies for the person receiving the meals. If none, please say: NONE *

Sunrise Breakfast Bowl - not heavily seasoned; may require salt/pepper

Oven Roasted Potatoes, Sautéed Bell Peppers and Onions, Fresh Tomatoes, and Scrambled Eggs

Regular with eggs

Substitute tofu for eggs

Add a Second Order of This Meal

Lemon Garlic Bow Tie Pasta (with or without breaded chicken breast)- not heavily seasoned; may require salt/peppper

Ingredients: Bow Tie Pasta, Asparagus, Cherry Tomatoes, Lemon Juice, Olive Oil, Garlic, Salt, Pepper.

Check here to add chicken breast

Without chicken breast

Add a Second Order of this Meal

Chicken & Apples with Roasted Red Potatoes

Chicken, Apples, Red Potatoes, Onion, Oil, Spices

Add a Second Order of this Meal

Clear selection

Buddha Picnk Bowl

Buckwheat Noodles, Cabbage, Peppers, Green Onions, and Sweet Potato Mixed in a Sweet Chili Sauce, Topped with Radishes

Add a Second Order of this Meal

Check here to add chicken breast

Mushroom Philly Bowl

Roasted Potatoes, Sautéed Mushrooms, Peppers, Onions, Cheddar Cheese (on side)

Check here to add chicken

Add a Second Order of This Meal

Please choose a snack to accompany your meal (optional)

Vegan Chocolate Chip Cookie (qty 2) - Dairy-free chocolate chips, Flour, Vegan Butter, Banana, Baking Soda, Vanilla, Brown Sugar, Sugar

Picnk Bites (5 pcs) - Dairy free; Contains nuts. Peanut Butter, Flax Seed, Oats, Honey and Dairy-Free Chocolate Chips

Please provide any additional instructions/requests about meals or delivery

I would like to receive emails from Picnk Dayton about additional food/menu options and services *

Yes

I would like to receive emails from Rainbow Elder Care *

Yes

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