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Proxy Form

Food is distributed via drive-through food sharing events in Cottonwood, Clarkdale, Prescott Valley, and Dewey-Humbolt. This form is for these distributions only.

If someone is unable to attend a Cottonwood, Clarkdale, Prescott Valley or Dewey-Humboldt food-sharing event for any reason, a "proxy" may be assigned on their behalf to pick up food for them.  Please fill out the form below to register a proxy.  Please allow 48 hours for the form to be entered into our system.

By filling out this form, you agree to our text and email communication and acknowledge you are within these income guidelines.


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