Family Pack Form

Please arrange your food parcel using this online form.

To collect:
Please come to our location "The Gateway" on Friday St, Chorley, PR6 0AA, during our opening times.

Deliveries:
We don't have a regular driver service, though we may occasionally be able to deliver in the Chorley area
in special circumstances, e.g. if you are COVID isolating or you have a disability.

Name *

First

Last

Phone Number *

Email *

Number of Adults *

Number & Ages of Children *

Note any special dietary requirements *

How has COVID-19 affected your family financially? *

Have become unemployed due to COVID-19 Have been laid off temporarily Hours at work have been reduced Extra costs incurred at home to feed my children

Details: *

Family Food Parcel *

I can pick it up (appointment will be allocated) I require a home delivery (special cases only)

Address (for home delivery) *

Line 1

Line 2

City

State

Zip Code

Country

Family Food Parcel Booking Form

Tel: 01257 220077 | reception@chth.org.uk
Registered Charity Nr: 1152392
Company Ltd By Guarantee Nr: 08380427

Family Food Parcel Booking Form

Tel: 01257 220077 | reception@chth.org.uk Registered Charity Nr: 1152392 ​Company Ltd By Guarantee Nr: 08380427

Tel: 01257 220077 | reception@chth.org.uk
Registered Charity Nr: 1152392
Company Ltd By Guarantee Nr: 08380427