Hadracha & Tomchei – Kids School Snack Request

If you would like to receive snacks for your children for school please fill in this form:
Please mark off which organization you are a client:
- Hadracha
- Tomchei Shabbos
All information will only be sent in confidence to the organization that you check off above.
Name*
First Last
Address*
Street Address
Apt #
Apartment Number if applicable
Buzzer
Buzzer Code if applicable
Special Delivery Instructions City Province Postal Code
How many members in each household:
Please write the amount of adults*
Please write the amount of boys*
Please write the amount of girls*
Snack Information:
Please write how many snacks you require in total for 1 week: (We will try our best to accommodate your requests)*
Do dairy snacks have to be Cholov Yisroel?*
- Yes
- No
Can we send snacks with nuts?*
- Yes
- No
Please describe any other food allergy or concerns:
Contact Information
Please provide your most up to date contact information:
Email Address*
Phone Type*
Phone Number:*
Phone Type
Phone Number 2:
Comments

How many members in each household: