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Long Beach Food Pantry Delivery
Registration Form

To register your interest, please complete the form below and press the submit button. Once we receive your registration form, we will contact you within 24 hours.

Do you or a family member have a disability prevents you from accessing our food pantry locations?
How often do you want food pantry delivery? ($10 fee per delivery)?

Please provide a working phone number for our driver to contact your prior to delivery.

Demographic Information: 

Marital Status:
Are you a Veteran:
Living Situation:

Physical Qualifications for Program:

Are you able to cook your own meals?
Do you have any food allergies?
List your food allergies?
Do you have CalFresh?
What type of groceries would you like to receive? (Please choose one option)
Occasionally, we receive rescued food from local markets, including items close to the sell-by date. They can include specialty foods like crackers, cereal, meats, cheese, vegetables, etc. Are you open to receiving rescued food?
If you don't receive CalFresh, are you interested in applying?

Geographic Information

Do you live in an apartment, house and or gated community?

If you are not home, drivers will leave your groceries at your front door, ring the doorbell or knock to receive your delivery. 

Thanks for submitting!

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