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Good Food Box

  1. Good Food Box Order Form

  2. I live in (please check one):

  3. Who is the box feeding?

    The Good Food Box would like to know how many people it has helped this month!

  4. Please include the number of adults.

  5. Please include the number of children.

  6. Please include the number of seniors.

  7. Please include the number of families.

  8. How are your pre-paying for your Box?*

    Payment must be received upon order. If not received your order will be cancelled.

  9. Electronic Transfer

    Please ensure all electronic transfer payments are emailed to goodfoodbox@chestermere.ca
    Use password: Chestermere

  10. Acknowledgment of pick-up times

    See pick-up date on the schedule on our website and or Good Food Box Facebook page. Pickups are between 1:30 pm to 4:00 pm, no holds.

  11. 2019 good food box

  12. Contact

    If you have any questions about the program please call (403) 207-7091.

  13. The personal information requested in this form is being collected for activities relating to the Good Food Box program and as such is determined to be an activity of the City of Chestermere. The personal information is collected under the authority of Section 33(1)(c) of the Freedom of Information and Protection of Privacy Act, and will be used only for the purposes identified. If you have any questions or concerns about the collection or use of information you may contact the FOIP Coordinator at City Hall, 105 Marina Road, Chestermere, AB T1X 1V7 or call (403) 207-7050.

  14. Leave This Blank:

  15. This field is not part of the form submission.