Postpartum Meal ApplicationThank you for your interest in the Honey and Lemon House! To apply for postpartum meals, please fill in the application below.Please note: you will also be offered this service if you apply to shop in store, or to receive a Newborn and Postpartum Pack (you do not have to fill out this seperate application). Your Information (applicant) Name * First Name Last Name Phone * (###) ### #### Email * How would you like to be contacted? Email Text Message Your Household How many children do you have, and what are their ages? Are you currently pregnant? Yes No If so, what is your approximate due date? Are there any other dependents in your household? (If so, please provide basic details): Needs Assesment What are your immediate needs? (e.g., financial assistance, housing, childcare, employment, education, healthcare, etc) What are you hoping to receive from the Honey and Lemon House? * Meals When are you in need of meals? * How many meals are you in need of? * Please list any dietary requirements for yourself, or anybody else within your household: * Consent and Agreement I consent to the use of my personal information by the Honey and Lemon House for the purpose of assessing this application and providing support for the intended recipient. * Yes No Liability Disclaimer By purchasing products or receiving services through the Honey and Lemon House, I acknowledge and agree that neither the Honey and Lemon House, Antioch Australia Ltd, nor any individual involved shall not be held liable for any damages, injuries, or losses incurred as a result of using these products, or receiving any services. All products are sold "as is," without any warranties or guarantees, either express or implied. The Honey and Lemon House does not assume any responsibility for the quality, safety, or effectiveness of the products sold, nor services rendered. It is the buyer's responsibility to use the products as intended and to adhere to any instructions or guidelines provided by the manufacturer. By proceeding with this application, you agree to release Honey and Lemon House from any and all liability related to their services. * I agree I disagree Date MM DD YYYY Optional How did you hear about the Honey and Lemon House? Thank you for your application! If successful, one of our volunteers will be in touch as soon as possible to set up a time for your consultation meeting. If unsuccessful, you will be notified via text or email.
