Hope Healthy Food Hamper Order Form You must be registered with the Healthy Food Bank to use this service. Orders must be received by Tuesday at noon of the week you want to pick up. Hampers are only available once per month. All pick-ups are on Thursdays between 11:00am and 1:00pm.About You & Your HouseholdName(Required) First Last Email PhoneNumber of adults(Required)Number of children(Required)What month would you like to pick up your hamper?(Required)Please specify the month you are hoping to pick up your hamper. JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberWhich Thursday would you like to pick up your healthy hamper?(Required)Hampers are available for pick up on the first three Thursdays of every month. Pick one Thursday only. First Thursday Second Thursday Third Thursday Do you have any allergies we should know about?(Required) Yes No If yes, please specify your allergies:Please select your packaging option:(Required) Paper Plastic Box Do you have access to cooking facilities?(Required) Yes No Do you have any dietary preferences?(Required) Meat Vegetarian Vegan None Other Please specify your other dietary preferences/restrictions:Your Order Check all items you are willing to receive. Please note that all items are subject to availability and selection will be based on your household size.Fresh Fruit and VegetablesSubject to Availability. Potatoes Onions Carrots Broccoli Oranges Apples Bananas Surprise Me! Non-PerishablesSubject to Availability. Tuna Baked Beans Rice Salmon Chickpeas Spaghetti Black Beans Canned Tomatoes Macaroni Kidney Beans Peanut Butter Oatmeal MeatSelect one only. Subject to availability. Chicken Beef Pork Frozen ItemsPlease note we may not have everything in stock. Frozen Vegetables Frozen Fruit Frozen Soup/Stew (made in our kitchen) Dairy and Alternatives Eggs Milk Bread and Bakery ProductsPlease select only two. Subject to availability. Whole Wheat Bread Rye Bread White Bread Bagels Buns Dessert Odds & SodsPlease note we may not have everything in stock. Toilet Paper Deodorant Face Masks Toothpaste Razor Can Opener Hand Sanitizer Hand Soap Dog Food Cat Food Laundry Detergent Menstrual Products Special RequestsPlease specifyNameThis field is for validation purposes and should be left unchanged.