Client Application

Please complete this form to sign up for services.

Once we have received your completed enrollment form, we will be in touch.

If you have not heard from our office within 48 hours, please call us at 307.635.5542

Your Information
Marital Status
Gender
Are you a Veteran?
Have you received meals from us before?
How Many Meals Would You Like to Receive Each Day?
Are you able to answer the door?
Are you working with a Social Worker or Case Manager?
Emergency Contact #1
Emergency Contact #2
PLEASE CHECK THAT YOU HAVE READ AND UNDERSTAND THE FOLLOWING:
Meal Cancellation or additions must be called in no later than 9:30am the day of delivery
You can call our office 24 hours a day and leave a message with your name if you need to cancel.
Meal delivery is normally between 11:00am and 1:00pm. Please note that outside factors (weather, traffic etc) my affect delivery time
If you will not be home at time of delivery, please call the office to let us know you will not be home and leave a cooler outside for your meal. If you receive a message from us, please call us to let us know you have received your meal and are ok.
If we do not hear from you and cannot reach you, we will attempt to contact your emergency contact(s) or contact the non-emergency police to do a wellness check, if necessary.
Drivers are only able to deliver meals.
I hereby grant Meals on Wheels of Cheyenne, Inc. all rights, title and interest in any and all photographs, video or audio recordings of or including my image or voice, to be used related to the mission of the organization.