Please complete this form so we have a count for the meal and we know how we can serve you better! Your name Your email Current Address or write homeless if you do not have one: Phone Number Do you have any dietary restrictions? If yes, please list them. Please check any needs that you have that we can assist you with: HousingObtaining state ID, Social Security Card, etc.Healthcare/Health InsuranceLearning how to budget moneyEmploymentShowerNo current concernsOther Please describe "Other": Would you like someone to pray with you today? If so please let one of the volunteers know. Yes pleaseNot today, thank you If you have prayer requests that we can pray for, please list them here and we will continue to pray. Please list any children you brought with you to the meal
