Nominate a Cast Member in Need  Survey

1.I understand Cast Member Pantry services are currently only available for Cast Members who are actively furloughed or have been laid off due to COVID or for Cast Members on an unpaid medical leave. (Required.)

Yes/Sí (for a furloughed CM)

Yes/Sí (has laid off from Disney due to COVID)

Yes/Sí (CM is on an unpaid medical leave)

2.First Name:
nombre primero:(Required.)

3.Last Name:
nombre apellido:(Required.)

4.Number of people in household:
Número de personas en su casa:(Required.)

1-2

3-4

5-6

6+

5.Any children under the age of three?
¿Tiene hijos menores de 3 años?(Required.)

Yes / Sí

No

6.YOUR (person nominating the CM) Email Address:
dirección de correo electrónico:(Required.)

7.Please confirm YOUR Email Address:
Por favor confirme su dirección de correo electrónico:(Required.)

8.YOUR (person nominating the CM) Phone Number:
número de teléfono:(Required.)

9.All Cast Member Pantry locations (FL, CA, HI) now use a grocery delivery service. Groceries are delivered to your home.

What is the address of the CAST MEMBER IN NEED?
¿Dónde le gustaría que le entregaran sus comestibles?(Required.)

Street Address:
Dirección:

City:
Ciudad:

Zip Code:
Código postal:

If you live in a gated complex, provide your gate code here.

10.Please indicate which type of grocery bag you would like to receive:
Indique qué tipo de bolsa de la compra le gustaría recibir:(Required.)

Regular Bag (No special dietary restrictions) / Bolsa regular (sin restricciones dietéticas especiales)

Vegan Bag / Bolso vegano

Gluten-Free Bag / Bolsa sin gluten

I have other dietary restrictions. Note: Please email us directly after completing this form with any special dietary needs not indicated here. We will not be able to accommodate preferences.
Tengo otras restricciones dietéticas. Nota: Envíenos un correo electrónico directamente después de completar este formulario con cualquier necesidad dietética especial que no se indique aquí. No podremos adaptarnos a las preferencias.