1 Welcome2 Personal Info3 Household Info4 Schedule5 Order6 Privacy Policy & Submit The Leesburg Market has updated procedures to receive food. You have the option of shopping in the market or placing an on-line order and receiving your food via curbside pick-up: When you come for your appointment, you will need to show a form of ID. LHR only serves people who live in Loudoun County. You will be asked to provide head of household name, address, phone number and date of birth plus number of individuals in the household and their ages when you schedule your appointment. About every six months, you will be asked to verify your household information and provide proof that you live in Loudoun. NEW VISITORS will be asked to fill out an application at the first visit and will be asked to verify household information and provide proof that you live in Loudoun at the first visit and about every six months thereafter. LHR serves anyone who lives in Loudoun County and needs food through our program. Food is for personal household use only and cannot be shared, bartered, or sold. Additional food is available through the USDA TEFAP program but requires additional verifications. Click here to review USDA Nondiscrimination Statement (ENG/ESP). In-person visits will allow for a grocery-store like experience. Your appointment time is a reserved time for you to shop in the market and make your food selections. For curbside pick-ups, grocery carts will be pre-packed. Special requests are limited. Visitors can expect to receive a variety of healthy grocery options they have selected from the list in this appointment form. LHR will not always have the items requested, but we do our best. When you arrive at LHR for your appointment: In-person Shopping: Please enter the market within 5 minutes of your appointment time and check-in at the front desk. Let the front desk know any special diet needs at check-in. Curbside pick-up: Please park in a designated “Curbside Pick-up” space and follow directions on the sign to call and notify of your arrival. Please remain in your car. Your groceries will be brought out to you, and you will then be able to load them in your vehicle. If you are more than 10 minutes early, you may be asked to wait until your appointment time. If you are more than 15 minutes late, you may be asked to wait until our team is able to serve you, or if there is no availability, you may be asked to return for another appointment at a different time. You will not be served without an appointment. Personal InformationNew Visitor*YesNoAre you a resident of Loudoun County?*YesNo We're sorry. Loudoun Hunger Relief services are only available to Loudoun County residents. Please call 211 or visit http://211.org to find services that are available in your area.Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number (cell preferred)*Email Date of Birth*Individuals must be over 18 to complete and submit an order Date Format: MM slash DD slash YYYY Household InformationSpecify how many people are you in your household.# of Adults Age 18-59012345678910# Older Adults Age 60+012345678910# of Children012345678910Child 1 Age01234567891011121314151617Child 2 Age01234567891011121314151617Child 3 Age01234567891011121314151617Child 4 Age01234567891011121314151617Child 5 Age01234567891011121314151617Child 6 Age01234567891011121314151617Child 7 Age01234567891011121314151617Child 8 Age01234567891011121314151617Child 9 Age01234567891011121314151617Child 10 Age01234567891011121314151617Household SizeAdultsAndSeniors CLICK ON ARROW BELOW FOR DROP DOWN TO SELECT EITHER IN-PERSON SHOPPING OR CURBSIDE PICK-UP*1) In-Person Shopping 2) Curbside Pick-up (prepacked) Schedule AppointmentLoudoun Hunger Relief 750 Miller Drive, Suite A-1 Leesburg, VA 20175Sterling Community Center 120 Enterprise Street Sterling, VA 20164Select pickup date and time.* November 2024 Sun Mon Tue Wed Thu Fri Sat 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 November 23, 2024 9:00 AM 9:10 AM 9:20 AM 9:30 AM 9:40 AM 9:50 AM 10:00 AM 10:10 AM 10:20 AM 10:30 AM 10:40 AM 10:50 AM 11:00 AM 11:10 AM 11:20 AM Curbside Pick-up Order DetailsIf you opt to have your order prepacked and then pick it up curbside, LHR can provide 3-5 days per visit of perishable & non-perishable food for your household if you select from all categories. Note: This food is pre-packed; however, we want you to have options about what you receive from us. Select below which categories you wish to receive. Substitutions from the choices below cannot be accommodated at this time.Do you need diapers?YesNoPick up to 2 preferred sizes Newborn diapers: Up to 10 lbs. Size 1: 8 - 14 lbs. Size 2: 12 - 18 lbs Size 3: 16 - 21 lbs. Size 4: 20 - 32 lbs. Size 5: 27 - 35 lbs. Size 6: Over 35 lbs Adult Diaper CommentsDo you need formula?Yes, Milk BasedYes, Soy BasedNoSpecific brands not guaranteedDo you need baby food?YesNoBaby Food CommentsWe will honor requests if we have the items, but that there are no guarantees.Select all the food categories you wish to receive this visit:Categories subject to availability. No substitutions will be made. Dried Beans or Lentils and Rice Deli/Prepared Foods (Sandwiches, cooked meals/meats, etc.) Misc. Dairy (Cheese, yogurt, etc.) Snacks (Crackers, chips, snack bars, etc.) Produce (Fresh fruit and vegetables) Bakery-Bread Only Bakery-Sweets Only Milk (Dairy, usually 2%) Eggs MASECA Corn Meal Flour Mixed shelf-stable items (ex: pasta or rice, beans, tomato sauce, canned vegetables) Select all the food categories you wish to receive this visitCategories subject to availability. No substitutions will be made.Non-perishable Bag/Box (Pasta, rice, beans, cereal, oatmeal, soup, tuna, vegetables, peanut butter, etc.)USDA Non-perishable Bag/Box (Certified households only. Nuts, pasta, dried beans, cooking oil, canned fruit, etc.)Milk (Dairy, usually 2%)Misc. Dairy (cheese, yogurt, etc.)EggsBakery-Bread onlyBakery-Sweets/Desserts onlyProduce (fresh fruits and vegetables)Deli/Prepared Foods (sandwiches, cooked meals/meats, etc.)Snacks (crackers, chips, snack bars, etc.)MASECA Corn Meal FlourDried Beans/Lentils and RiceDo you eat pork?(Including ham, bacon, sausage, chops, etc.)YesNoOther Protein OptionsSelect all that apply. Not all selections available daily. Venison (Deer Meat) Chicken Beef Halal Only Seafood/Fish No Meat - Plant-based Only Organ Meat (liver, tongue, kidney, etc.) Do you need dog food?YesNoDo you need cat food?YesNoAdditional Requests/Dietary Limitations (Limit to 3 Items)We will honor requests if we have the items, but there are no guarantees. Please Note: In the event of allergies or special dietary needs, we do our best to ensure you receive compatible food items, but it is your responsibility to check the ingredients of all food received.Are you financially impacted by COVID-19?*YesNoConsidering all the food you buy or receive, does what you get from Loudoun Hunger improve the amount of food you have?*Yes, now we have enoughNo, we need additional foodN/A, first visitIf you answered "No, we need additional food" above, please share why.In-Person Shopping Order DetailsAre you financially impacted by COVID-19?*YesNoConsidering all the food you buy or receive, does what you get from Loudoun Hunger improve the amount of food you have?*Yes, now we have enoughNo, we need additional foodN/A, first visitIf you answered "No, we need additional food" above, please share why. Privacy Policy and Submission Statement By accepting this Donation, I acknowledge that Loudoun Hunger Relief, Inc. (LHR), a recognized 501c3 food pantry under Title 13.1, Chapter 10 of the Code of Virginia, is immune from civil liability arising from the Donation. I understand that in requesting assistance from LHR, that LHR may request information from other agencies in order to determine your need. LHR will not share the information you have provided to us with other agencies or organizations, except with Blue Ridge Area Food Bank and in connection with a lawful investigation of a suspected crime occurring on our premises or in our parking lot. Inappropriate behavior and profane comments may also result in suspension or termination of services. Under no circumstances will LHR serve anyone who is intoxicated or under the influence of illegal drugs. Statement of Non-Discrimination In accordance with Federal Law and U.S. Department of Agriculture Policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. To file a complaint alleging discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Ave, SW Washington, DC 20250-9410 or call toll free (866)632-9992 (voice). Individuals who are hearing impaired or have speech difficulties may contact USDA through the Federal Relay at (800)845-8339 or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer. Agreement* I agree to the terms of service.CommentsThis field is for validation purposes and should be left unchanged.
