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Meal Service Application

The Bridge Initiative exsists to support individuals and families facing medical hardship by providing nutritious, home-cooked meals. Please answer the questions below so we can determine eligibility and a best way to serve you and your family

Applicant Information

Household Information

How many people live in your household?

Why are you requesting assistance?

(Check all that apply)

Medical Hardship

Has your household experienced one of the following within the last 12 months? (click all that apply)

Insurance

Which best describes your situation?
Uninsured
Underinsured
Insured but experiencing financial hardship
Prefer not to answer

Financial Need

Which best describes your household?
Loss of income due to illness
Unable to work because of illness
Significant medical bills
Other financial hardship

Dietary Needs

Diet restrictions? (click all that apply)

Delivery Availability

What days would be the best to receive a meal on? (click all that apply)

Short Answer

Consent and Acknowledgment

 I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that The Bridge Initiative provides home-cooked meals through volunteers at no cost to eligible recipients and that approval is based on program eligibility and available resources.


I understand that meals are prepared and delivered by volunteers and may be prepared in home kitchens. While The Bridge Initiative encourages safe food handling practices, I acknowledge that there are inherent risks associated with consuming prepared food, including foodborne illness or allergic reactions. By accepting meals through this program, I voluntarily assume these risks and release The Bridge Initiative, its volunteers, and its partners from liability to the fullest extent permitted by law, except in cases of gross negligence or willful misconduct.


I authorize The Bridge Initiative to use the information provided in this application to determine eligibility, coordinate meal services, and administer the program. By checking this box, I consent to receive meal assistance and agree to the terms above.

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