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?
1
2
3
4
5
6
7
8
9
10
COVID-19 Kit
COVID-19 Kits include: Masks, Reusable Thermometer, Hand Sanitizer
$
Free
How many would you like?
1
2
3
4
5
6
7
8
9
10
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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