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Seniors Form for Grocery Delivery
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What is your name?
Your answer
What is your address (including apartment number if you live in one)?
Your answer
What is your phone number?
Your answer
What groceries do you need?
Your answer
Do you have any preferences or requirements (e.g. organic/allergies/preferred store)?
Your answer
When do you need this by?
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When are you available to receive the delivery (please provide specific times/dates)?
Your answer
Privacy Agreement: I, the undersigned, do hereby allow the members of the Teens Helping Seniors organization to use the information enclosed within this Google Form (including my name, address, phone number, and other identifying contact information) to fulfill contactless supply delivery to me. I give full permission to Teens Helping Seniors to provide this information to organization volunteers, if necessary. Further, I waive all rights to legal action or recourse against the members of Teens Helping Seniors in regards to the usage of my identifying contact information for the purpose of contactless supply delivery to me. By signing this document, I hereby affirm that I have read and agree to the Teens Helping Seniors User Privacy Policy to be found at
https://tinyurl.com/seniorprivacy
.
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