Christmas LHFP Meal Box Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this registration prior to the Christmas food box pick up on Saturday, December 17th at 10am. Please pick up your food box from Baptist Grove Church at 7109 Leesville Rd. Raleigh, NC 27613. If you have any questions or need further assistance, contact our Outreach Coordinator, Suzette Aiken via email at outreach@baptistgrovechurch.org or call us at (919)787-4528.

Click HERE to view the content of the Holiday Food Box.

Email *

First Name *

Last Name *

Email Address *

Phone Number *

Race/Ethnicity *

American Indian or Alaska Native

Asian or Pacific Islander

Black

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Other:

Gender *

Male

Female

Other:

Home Address *

Number of Children in your household (0-19) *

Number of Adults in your household (20-54) *

Number of Seniors in your household (55+) *

Total Number of Individuals Living in your home *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Baptist Grove Church. Report Abuse

Forms