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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.

Are you at least 60 years old?
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: 

Gender:
Marital Status:
Are you a Veteran:
Ethnicity:
Living Situation:

Emergency Contact Information:

Physical Qualifications for Program:

Are you able to cook your own meals?

Food Delivery Preferences:

Deliveries will be scheduled once a week according to your zip code, we will get as close to your preferred time as possible.

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Select two days and a time you would prefer your groceries delivered:

1st Preference:
2nd Preference:
What is your preferred delivery time?
Do you have any food allergies?
List your food allergies?

Geographic Information

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

If you are not home or prefer contactless delivery, 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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