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Nutrition Knights Food Pantry Delivery
Registration Form

Cesar Chavez Elementary School Grocery Grab N Go clients, please complete the form below and press the submit button.  
* To be eligible, you must have a child attending Cesar Chavez Elementary School.

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

Demographic Information: 

Gender:
Are you a Veteran:
Marital Status:
Do you have children attending Cesar Chavez Elementary School?
Ethnicity:

Emergency Contact Information:

Food Delivery Preferences:

Deliveries are scheduled once every other week, and according to your zip code. We will get as clost to your preferred time as possible. Please select a day and time someone is home to receive the delivery.

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Select your prefered delivery day and a time you would like your groceries delivered:

1st Preference:
2nd Preference:
What is your preferred delivery time?

Grocery Preference InformationY

You may select up to 3 bags (one of each) from the following options (For example, you may choice to receive all 3 bags (all options) or Produce Bag and Protein Bags, or only a Produce Bag or Protein Bag)

Grocery Bags
Produce Bags
Protein Bags

Comments:

Press Submit Registration Form button before downloading the Alternative Pick-up Form below.             

Thanks for submitting!

To complete your registration, please download and complete the Alternative Pick-up Form and email it to: info@helpmehelpu.org or post it to:

Help Me Help You

PO Box 32861

Long Beach, CA 90832

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