FACE food box request form

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For those wishing to have food box delivered, or to collect from FACE

Please tell us why you are requesting a food box from FACE. We are able to deliver by volunteer only to those Shielding or Self-isolated. *

I am shielding, due to being extremely clinical vulnerable, and wish for a volunteer to deliver.

I am self-isolating due to someone within my home showing symptoms of Covid19, or being in recovery from Covid19 and wish for a volunteer to deliver.

I am self-isolating as I am 'at risk' due to being over 70 or having underlying health issues which could require me to be hospitalised if I catch Covid19 and would like a volunteer to deliver.

I am buying the box for a family member/friend or neighbour who is in one of these categories and would like a volunteer to deliver.

I would like to collect the box from FACE, to reduce the need to go to supermarket, I am Covid19 symptom-free, and everyone in my household is symptom-free.

Other:

What is your name and telephone number/email? This is needed in case we have a query about your request. If you wish to collect the box, we will contact you to arrange a good time. The box will be placed in the foyer of FACE, youth centre, Elm Park, BS34 7PS. Please do not come until we have contacted you to say your box is ready. *

What is the delivery address for the food parcel if you wish a volunteer to deliver? If the box is not for yourself, please also give your the name of the person to whom you wish the box to be delivered. We can only deliver to addresses in FILTON or CHESWICK VILLAGE. *

Within the box there will be UHT milk. Which do you prefer...? *

Skimmed milk

Semi-skimmed milk

Whole milk

Other:

Do you have any allergies or dietary needs? *

NONE

Gluten free

Dairy free

Vegetarian

Vegan

Other:

Please choose from the following options for your food box...(please note box contents may vary due to product availability) *

Tins/jars, 6 eggs, UHT milk and bakery goods to the value of £20

Tins/jars, 6 eggs, UHT milk, bakery goods and 4 toilet rolls, to the value of £20

Tins/jars, 6 eggs, UHT milk, bakery goods and fresh fruit/veg, to the value of £25

Tins/jars, 6 eggs, UHT milk, bakery goods, fresh fruit/veg and 4 toilet rolls, to the value of £25

Other:

Required

Is there anything you'd like to tell us about the food you would prefer? We cannot guarantee to meet exact needs but we do have a range of products! (e.g. how many people live with you? Do you hate mushrooms? Do you drink tea / coffee? Do you prefer tinned veg to tinned soup, etc.) *

How would you like to pay for your box? *

PayPal to covid19@facefilton.org.uk

Online or by phone banking transfer (we can give you account details)

Cash to volunteer on delivery (in a sealed envelope please to be placed safely for the volunteer to pick up e.g. from the floor/porch)

I will need a donated box as have no means of paying, please contact me to discuss

Other:

Finally, what is today's date? *

YYYY

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