Covid-19 Emergency Food Parcel Delivery Service
Please complete this form if you require emergency food delivery (please do not exploit or misuse this service as vulnerable people may suffer as a result). We are only able to provide ONE food parcel per household each week. Please do not apply for more than one parcel each week.

PLEASE NOTE: We are only able to deliver to residents of the Beaumont Leys or Abbey ward, Leicester, UK. If you are unsure which ward you are in please use your postcode to find out here: https://www.leicester.gov.uk/your-council/councillors-and-wards/your-ward/ 
Sign in to Google to save your progress. Learn more
Full Name *
Full Address *
Postcode *
Contact Number,  Please ensure this is correct as we will contact you with your Allocated delivery Day. *
Email Address *
Do you live in a flat or house? *
Adult Age *
Date of Birth *
MM
/
DD
/
YYYY
Are You On Benefits *
Your Ethnicity *
Self-Isolated Y / N *
Do you have any allergies? *
Do you have any dietary requirement? Please state below: *
If you have dependents, how many? *
Would you need a weekly or fortnightly emergency food parcel delivered? *
I agree to treat E2 staff and volunteers, and other service users with respect and will not direct verbal,  physical, or any other type of abuse towards them. *
If you are outside of the area we work, do you consent to us passing your personal information onto your local ward councillor or local representative who can take your support request? *
I agree to my personal information being held by E2. Any personal information that you provide will be processed in accordance with the Data Protection Act 1998. It will be used by us and our delivery partners to deliver and improve services and fulfill our statutory and charitable duties. Non-personalised data such as house number and postcode data will be shared and crosschecked with Leicester City Council and partners to ensure there is no duplication of service provision. We will only share your data with Ward Leads of the Leicester Covid-19 Mutual Aid Group and volunteer delivery drivers. We will not share your data with any other third-party without your express consent. I agree with my contact information being used should E2 and Ward Leads of Leicester Covid-19 Mutual Aid Group and volunteer delivery drivers need to contact me. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of E2. Report Abuse
Google Forms