Order Safety Kits

Order Free Safety Kits

Kits are provided and distributed by Proactive Community Services. Orders are processed on a first-come, first-served basis. If you need to order more than 10 of each kit, please call us at (331) 256-7854.
Which kits would you like to order? *
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Safe Sex Kit Safe Sex Kits include: XL Condoms, Ultra Thin Condoms, Lube, Flavored Lube
Free How many would you like?

COVID-19 Kit COVID-19 Kits include: Masks, Reusable Thermometer, Hand Sanitizer
Free How many would you like?
What is your name? *

First Name Last Name
What is your age? *
What is your phone number? *

Area Code Phone Number
What is your email address? *
example@example.com
How do you identify your gender? *

Female Male Trans Male Trans Female Non-Binary
What is your ethnicity? *

Hispanic or Latino/Latinx Not Hispanic or Latino/Latinx Declined Don't Know
What is your race? *

Black / African American White Alaskan Native Asian Native American Native Hawaiian Pacific Islander Declined Don't Know
What is your housing situation? *

Stably Housed At Risk of being Homeless Homeless
What is your current employment status? *

Employed Not employed
Would you prefer to pick these up or have them delivered? *

Pick up Delivery
What is your delivery address? *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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Order Free Safety Kits