Food Distribution December 20, 2021 *** 1:00pm-7:00pm

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Last Name *

First Name *

Home Address *

Zip Code *

Cell Phone *

email Address *

Number of School Age Children *

Total Household Members *

Age of Applicant *

How did you hear about this food drive? *

Have you participated in this food drive before? *

Yes

Annual Household Income *

Race or Ethnicity *

If unemployed, for how long? *

Does your family receive housing, food or financial assistance? *

Yes

Are you or any of your family members disabled? *

Yes

Would you like to be contacted to volunteer? *

Yes

By typing your name and date here, you agree to hold harmless all members, donors, volunteers and associates of the One City Celebration Food Drive and Full Circle Foundation for the quality of the food received. Additionally, you agree to waive all rights to any legal action against any and all individuals involved in the execution of this activity. *

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