Register for Holidays On Wheels In partnership with Metropolitan Ministries Please submit one form per household. Your delivery is confirmed once you speak with a Network to End Hunger/Meals On Wheels for Kids staff member on the telephone to confirm the details. *required I would like to receive the following Holidays On Wheels deliveries (select one or more)*: Thanksgiving delivery on Tuesday, November 17 (a full holiday meal for children and members of household)Holiday delivery on Wednesday, December 16 (a full holiday meal for children and members of household, along with toys for children) Your Information (For adult only, information for children will be collected later in application) *required First Name*: Middle Initial: Last Name*: Phone*: Secondary Phone: Email*: Birthday (Month/Day/Year)*: Do you participate in SNAP or WIC programs?*: NoYes, SNAPYes, WICYes, Both How did you hear about Meals On Wheels for Kids?*: SchoolPantryFlyerSelfSomeone who receives mealsOtherSocial MediaTV/News/PrintFamily/FriendInternetSocial Worker/Case ManagerVolunteer Household & Children Information *required Address*: Name of Apartment Complex/Gate Code: City*: Zip*: County*: HillsboroughPascoPinellas What is your household size (adults + children)?* How many children live in your household (18yrs or younger)?* Your relationship to children in household?* ---MotherFatherGrandmotherGrandfatherUncleAuntSisterBrotherBabysitterOther How does your family identify the race of the household? Select all that apply. (required)Asian or Pacific IslanderNative American or American IndianBlack or African AmericanHispanic or LatinoWhiteOther FOR EACH CHILD, list the FIRST NAME, LAST NAME, GENDER, and BIRTHDAY below. (required) Does your child or children participate in the free/reduced lunch program?* YesNo Does your household have access to a working or reliable vehicle for life-sustaining trips: medical, grocery, work, job-related training/education and other vital services?* YesNo Is your household lead by adult with disability or illness?* YesNo Primary language spoken in household?* EnglishSpanishOther Will an adult 18 yrs or older be home during meal delivery?* NoYes Do you have pets?* CatDogNo Secondary Contact Information (Please provide contact information for someone who will be home to receive the delivery, in the event that you will not be home) Emergency First Name Emergency Last Name Emergency Contact Phone Emergency Contact Relationship MotherFatherGrandmotherGrandfatherUncleAuntSisterBrotherBabysitterOther Please read and respond to the following statements *required I acknowledge that Meals On Wheels for Kids, a Tampa Bay Network to End Hunger (TBNEH) program, will deliver a one-time Thanksgiving delivery on Tuesday, November 17 and a one-time Christmas Delivery on Wednesday, December 16 to the address listed above. Meal ingredients and toys will be delivered by volunteer drivers who have received a background check. I give permission for the Meals On Wheels for Kids volunteers to deliver meals to the household listed above, even if no responsible adult is present on the day of delivery.* YesNo I will enforce social distancing and I understand that volunteer drivers delivering the food will enforce social distancing. I will allow volunteers to place the delivery items at my front door, then knock on the door or ring the doorbell, and step away, while someone from my home retrieves the items. I will practice social distancing by not touching the volunteers, taking food from each other, or coming within 6 ft of them.* YesNo I understand that if I live in an apartment complex and in an area that delivers MOW4Kids with school buses, volunteers will call me when they are 15 minutes away and I will meet the school bus at the front of the apartment complex to receive my delivery. I will stand back and practice social distancing while awaiting direction from volunteers to retrieve the delivery.* YesNo I understand that someone must be home to receive the delivery between 10am-2pm on the delivery day. I will notify TBNEH/Meals On Wheels for Kids by calling 813-344-5837 if no one will be home to receive the delivery. I will notify TBNEH/Meals On Wheels for Kids at least 2 business days (M-F) before my scheduled delivery. If I don't call in advance and no one is home to receive the delivery, I will no longer be able to participate in the program.* YesNo Sign and Date First and Last Name*: Date*: Please click Submit when all fields have been completed.