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Sign Up for Meals

Sign Up for Meals

Folder: Get Involved

Sign Up for Meals

Sign Up for Meals

Do you, your family, or a loved one need access to healthy and nutritious food? Columbia Kitchen is here to help!

Simply register using the form below. A member of our team will be in touch to verify your eligibility. Then we’ll set up your deliveries, at no cost to you.

Name *

First Name

Last Name

Email *

Mobile Phone

(###)

###

####

Home Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (name and phone number) *

Family size (# adults / # children) *

How many meals do you need each week? (total for all family members) *

Ages of household members *

Race/ethnicity of household members (optional)

Asian/Pacific Islander

Black

Hispanic

Multiracial

Native American

White

Prefer not to say

Are you currently employed? *

Yes

No

Do you receive any of the following? (Check all that apply)

SNAP

SSDI

Medicaid

Housing Assistance

Veterans benefits

Meals on wheels

TANF

Do you experience any of the following needs/challenges? (Check all that apply)

Mental/physical health issues

Age-related issues

Lack of or unstable employment

Veteran status

Lack of housing

Lack of transportation

Notes or special requests:

Thank you! A member of our team will be in touch with you as soon as possible.

First Name

Last Name

Email Address

Thank you for signing up!

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Columbia Kitchen

PO Box 268

Hudson, NY 12534

518-751-0764