Application Form

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 100% of survey complete.

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* 1. What is your First Name?

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* 2. What is your Last Name?

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* 3. What is your Phone Number?

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* 4. What is your Email Address?

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* 5. What is your Home Address ( You Must live within a 10 Mile radius of our warehouse located at 1133 Wilso Drive Baltimore MD 21223 to qualify for our program )

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* 6. How did you hear about the Food Rescue To Go program?

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* 7. What is your Household Income level?

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* 8. Which ethnicity best describes you? 

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* 9. How many members are there in your household?

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* 10. Please list the ages in your household.

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* 11. What is your current means of transportation?

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* 12. Does anyone in your household have physical disabilities that limit their access to food resources?

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* 13. Does anyone in your household have food allergies?

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* 14. Do you Understand this statement?
The food that you will be receiving are from our Food rescue, also called food recovery operations.  This is the practice of collecting fresh, edible food that would have otherwise gone to waste from local food distributors and farms. These are items that may not past the eye test but will past the taste test. 

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* 15. I understand that I will receive an Email on days that food items are available by 11am and will have until 12 noon ( 1 hour duration )to respond if interested in the items for that day. Daily distributions are not guaranteed and items change or could be the same daily. 

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* 16. I agree and Understand that 4MyCiTy Inc. Is a nonprofit organization and is doing this service Free of charge to me and or my family on a voluntary basis. This program is not a guaranteed program and can end at anytime without notice. 4MyCiTy does not guarantee certain types of food items or the availability of a selection of items, whatever is rescued will be what is offered as available. This program is designed to help reduce food waste while effectively supporting individuals and families that may be facing food insecurity. Your participation in the program is voluntary and can be terminated at any time. 4MyCiTy will not be help liable for any issues resulting from food consumed through participation in this program, all food items are donated in good-faith and handled according to proper food handling practices.

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