Intake form

Name *

Email address *

What is your primary reason for seeking assistance?

Please select at least one option.

Food insecurity

Low income

Homelessness

How many individuals are in your household?

What is your current living situation?

What type of meals do you prefer?

Please select at least one option.

Vegetarian

Vegan

Gluten-free

Meat-based

No preference

Do you have any dietary restrictions?

Which service or services are you interested in?

Please select at least one option.

Ready-to-Eat meals

Community meal events

Additional questions or comments

City Cafe Outreach Program