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Blessing Box Request Form
Please help us get to know you/your family and your needs so we can best help you.
How many people are in your household needing assistance with food?
1-2
3-4
5+
What are the ages of those in the household needing food assistance?
Do you have any dietary restrictions or food allergies? Please select all that apply.
Gluten Free
Dairy Free
Vegetarian
Other
None
If "other" please specify or if additional details are needed for the above question, please add them here. If none, please put "N/A".
Please select any and all options available to you for meal preparation/storage.
Stove top
Oven
Microwave
Air Fryer
Refrigerator
Freezer
Toaster Oven
None
We are located at 10411 Bailey Dr. NE in Lowell. Pick up dates and times are subject to change, but our first pick up date will be Saturday, Nov 22. Will you be able to pick up your blessing box or will you need it delivered?
I can pick up.
I will need delivery.
I'm not sure at this time.
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