Food Support Application – 一般社団法人ジャンティーユ

Food Support Application Form

■Full Name

■E-mail

■ID you can bring

■Your Current Situation

Please bring one document that matches your situation. See the Important Notes for details

■Choose Your Pickup Date
3/6 Fri 16:30–20:00 (Full)3/14 Sat 14:30–17:00 (Available)3/28 Sat 14:30–17:00 (Available)
One visit per month per household. Two visits per month if you have two or more children under 18

■Transportation Support (Optional)

Select only if you use public transportation

■Questions / Additional Information

■Agree to the following Important Notes (Check the box)
Agree

After application, we will send you a confirmation email. Please make sure to check it.

Documents to Bring (First Visit Only)

Please bring ID and one document that matches your situation: We only check the documents. We do NOT copy them.

-Single parent → Child allowance / Medical subsidy card / Residence certificate

-Disability → Disability certificate

-Illness → Medical certificate or hospital documents

-Home care → Care service documents

-Multiple children → Child insurance card or residence certificate

Location

Sasazuka Community Hall (Sasazuka kuminkaikan) – 4th Floor

3-1-9 Sasazuka Shibuya-ku, Tokyo 150-0073

-8-minute walk from Sasazuka Station (Keio Line / Toei Shinjuku Line)

-1-minute walk from “Sasazuka Junior High School” bus stop (Keio Bus)

Important Notes

-Not available for Public Assistance recipients, pension recipients, or minors

-Bring your own bag

-No parking

-Please manage food safely and check expiration dates

-We may refuse future use if deemed inappropriate

-Personal information is strictly protected

For questions, contact us:

Email: iwatakentaro.gentille@gmail.com