A Basket Of Cheer! Food Basket Sign-Up
This form is for your household to register for the ABOC food basket list. Submissions are processed in the order they are received. Food baskets are "first come first served" basis. Submissions are usually high during the October-February months. **Please note that turkeys ARE NOT GUARANTEED in the holiday baskets**
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Email *
Name *
First and Last name
Contact Number(s) *
Please include "(text)" after the number entered if you approve texts as an alternate way to contact you. Ex: 301-485-9698 (text)
Address *
Please enter your ENTIRE address
Have you received food baskets from us before? If so, when? List the 3 most recent dates. (month & year). *
How many people are in your household? *
Please include yourself in this count.
Family Roster *
Please list the genders and ages of all the people in your household. Please include yourself.
Is anyone is your household disabled? If so, which person(s) from your family roster list. *
What is your annual household income? *
This information is used for statistical purposes.
What hardships or situtations have made it hard for you to keep food in your household? *
Ex: 1) I was recently laid off of a longtime job.  Ex: 2) I have a new member in my household and I need more help.
Are you in need of food assistance: *
Are you signing up for the: *
What 3 things are you in most need of? *
Pick your top 3 ONLY!
Required
Would you be interested in a monthly food basket service for your household? *
What is the best way to contact you? *
Required
What is the best TIME to contact you? *
Check all that apply.
Required
What is the best time of day to schedule your food basket pick-up? *
The delivery option is available to senior citizens, people with disabilities, veterans and special cases.
How did you hear about the ABOC food basket sign-up? *
Are you on social media? If so, what is your name and on what social media site(s) *
For example: @wowuradio (twitter) | www.instagram.com/wowuradio | W.O.W Radio (Facebook)
Comments | Inquiries | Notes
Do you have any additional information that you would like to share with us? Do
A copy of your responses will be emailed to the address you provided.
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