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Boxes of Love Recipient Application 2018

Please complete the following information. Incomplete forms may not be processed.

Pick-Up Site:

Head of Household Information

First Name*

Last Name*

Home Phone

Alternate/Cell Phone

Address

House # Street

Apartment

City

State

Zip Code

Gender

DOB (mm/dd/yyyy)

Total # in Household

Children 17 & Under

Primary Language

Interpreter Needed?

Child Information

*AGE: If child is under 12 months record their age as 0. Please use whole numbers only - no letters.

Delete?

Child First Name

Child Last Name

DOB (mm/dd/yyyy)

Age
(0-17 yrs)

Gender: M or F

Showed ID

Other Adult Information

				*List other adults NOT the main adult on the form.
	Adult First Name	Adult Last Name	DOB (yyyy/mm/dd)	Gender

Notes/Comments

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id="cmsmasters_row_63d62eb0916a72_45890069" class="cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed"> <div class="cmsmasters_row_outer_parent"> <div class="cmsmasters_row_outer"> <div class="cmsmasters_row_inner"> <div class="cmsmasters_row_margin"> <div class="cmsmasters_column one_first"> <style type="text/css"> #cmsmasters_heading_63d62eb09186f0_56785251 { text-align:center; margin-top:0px; margin-bottom:20px; } #cmsmasters_heading_63d62eb09186f0_56785251 .cmsmasters_heading { text-align:center; } #cmsmasters_heading_63d62eb09186f0_56785251 .cmsmasters_heading, #cmsmasters_heading_63d62eb09186f0_56785251 .cmsmasters_heading a { font-weight:normal; font-style:normal; } #cmsmasters_heading_63d62eb09186f0_56785251 .cmsmasters_heading_divider { } </style> <div id="cmsmasters_heading_63d62eb09186f0_56785251" class="cmsmasters_heading_wrap cmsmasters_heading_align_center"> <h1 class="cmsmasters_heading">January-February 2021</h1> </div> </div> </div> </div> </div> </div> </div> <div id="cmsmasters_row_63d62eb0918c19_43284708" class="cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed"> <div class="cmsmasters_row_outer_parent"> <div class="cmsmasters_row_outer"> <div class="cmsmasters_row_inner"> <div class="cmsmasters_row_margin"> <div class="cmsmasters_column one_first"> <div class="cmsmasters_text"> <h2 style="text-align: center;"><strong>ALL VOLUNTEERS MUST PRE-REGISTER</strong></h2> <h3 style="text-align: center;"><a href="https://www.signupgenius.com/go/BDCJAN2021" target="_blank" rel="noopener noreferrer">REGISTER FOR JANUARY EVENTS</a> | <a href="https://www.signupgenius.com/go/BDCFEB2021" target="_blank" rel="noopener noreferrer">REGISTER FOR FEBRUARY EVENTS</a></h3> </div> </div> </div> </div> </div> </div> </div> <style type="text/css"> #cmsmasters_row_63d62eb091a1e8_84008051 .cmsmasters_row_outer_parent { padding-top: 0px; } #cmsmasters_row_63d62eb091a1e8_84008051 .cmsmasters_row_outer_parent { padding-bottom: 50px; } </style><div id="cmsmasters_row_63d62eb091a1e8_84008051" class="cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed"> <div class="cmsmasters_row_outer_parent"> <div class="cmsmasters_row_outer"> <div class="cmsmasters_row_inner"> <div class="cmsmasters_row_margin"> <div class="cmsmasters_column one_first"> <div class="cmsmasters_wrap_table"><table class="cmsmasters_table"><caption></caption><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h1>SUN</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>MON</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>TUE</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>WED</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>THU</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>FRI</h1> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h1>SAT</h1> <p></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 17</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 18</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 19</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 20</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 21</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 22</h2> <p><b>3:00 PM MOBILE FOOD PANTRY</b> Stuyvesant Apartments 245 Elmwood Avenue <b>4:30 PM MOBILE FOOD PANTRY</b> Arkansas Street <i>Behind McDonald’s on West Ferry</i> <a href="https://www.signupgenius.com/go/BDCJAN2021">CLICK HERE TO REGISTER</a></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 23</h2> <p><b>10:00 AM DISTRIBUTING FLYERS</b> Meet @ BDC 286 Lafayette Ave <a href="https://www.signupgenius.com/go/BDCJAN2021">CLICK HERE TO REGISTER</a> <b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 24</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 25</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 26</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 27</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 28</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 29</h2> <p><b>4:00 PM HOME DELIVERIES</b> BDC Outreach Center 437 Masten Avenue <b>**Drivers are needed.</b> <a href="https://www.signupgenius.com/go/BDCJAN2021">CLICK HERE TO REGISTER</a> </td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 30</h2> <p><b>2:00 PM MOBILE FOOD PANTRY</b> Buffalo Dream Center 286 Lafayette Avenue <a href="https://www.signupgenius.com/go/BDCJAN2021">CLICK HERE TO REGISTER</a> <b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>JAN 31</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 1</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 2</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 3</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 4</h2> <p><b>6:00 PM – 9:00 PM BAGGING GROCERIES</b> BDC Outreach Center 437 Masten Avenue <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a> </td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 5</h2> <p><b>1:00 PM MOBILE FOOD PANTRY</b> Chippewa Hotel 47 West Chippewa St <b>3:00 PM MOBILE FOOD PANTRY</b> Lafayette Linwood Seniors Apts 637 Linwood Ave <b>4:30 PM MOBILE FOOD PANTRY</b> Frederick Douglass Community Center 234 Jefferson Ave <i>Parking Lot</i> <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 6</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 7</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 8</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b> </td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 2</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 10</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 11</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 12</h2> <p><b>3:00 PM MOBILE FOOD PANTRY</b> Elmwood Square Apts 505 Elmwood Ave <b>4:30 PM MOBILE FOOD PANTRY</b> Church of the Assumption 435 Amherst Street <i>Parking Lot</i> <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 13</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 14</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 15</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 16</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 17</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 18</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 19</h2> <p><b>1:00 PM MOBILE FOOD PANTRY</b> Stadnitski Apts 100 Beck St <b>2:30 PM MOBILE FOOD PANTRY</b> Mullen Manor 200 Mineral Springs <b>4:30 PM MOBILE FOOD PANTRY</b> BDC Outreach Center 437 Masten Ave <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 20</h2> <p><b>2:00 PM TABLE OF GRACE</b> <i>Feeding the homeless</i> Fireman’s Park Corner of Ellicott St & North Division <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a> <b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 21</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 22</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 23</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 24</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 25</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 26</h2> <p><b>3:00 PM MOBILE FOOD PANTRY</b> Stuyvesant Apts 245 Elmwood Ave <b>4:30 PM MOBILE FOOD PANTRY</b> Arkansas Street <i>behind McDonald’s on West Ferry</i> <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 27</h2> <p><b>11:00 AM – 2:00 PM BAGGING GROCERIES</b> BDC Outreach Center 437 Masten Ave <b>11:00 AM HOME DELIVERIES</b> BDC Outreach Center 437 Masten Ave <a href="https://www.signupgenius.com/go/BDCFEB2021">CLICK HERE TO REGISTER</a> <b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr><tr><td class="cmsmasters_table_cell_aligncenter"></p> <h2>FEB 28</h2> <p><b>10:00 AM Curbside Church</b> <i>Outreach to the homeless</i> Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 1</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 2</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 3</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 4</h2> <p></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 5</h2> <p><b>MOBILE FOOD PANTRIES</b> <i>Check Back For Updated Info</i></td><td class="cmsmasters_table_cell_aligncenter"></p> <h2>MAR 6</h2> <p><b>7:00 PM Friends Feeding Friends</b> Fireman’s Park Corner of Ellicott St and North Division St <i>Near the downtown bus station</i> <b>**REGISTRATION NOT REQUIRED FOR THIS EVENT**</b></td></tr></table></div> </div> </div> </div> </div> </div> </div> </p> </div> <button type="button" class="pum-close popmake-close" aria-label="Close"> CLOSE </button> </div> </div> <script> /* <![CDATA[ */var tribe_l10n_datatables = {"aria":{"sort_ascending":": activate to sort column ascending","sort_descending":": activate to sort column 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