Consent for Home Meal Delivery
Families who have a critical need for home delivery due to a medically compromised child or lack of transportation may request to have meals delivered to their home. Home delivery is limited to those who have children who are medically compromised or have no way to get to one of our drive up or drop off sites.

I give consent to Burnsville-Eagan-Savage School District 191 to deliver meals to my home during the novel coronavirus (COVID-19) school closure. I understand that household contact information may be shared with school staff, volunteer deliverers or private delivery vendors such as bus transportation contractors. I also give consent for meals to be left if no one is home at the time of delivery.

For more information, you may call Stephanie White at 952-707-6261 or email at stwhite@isd191.org.  Staff members assisting a family should contact Jo Ann Nagy through email at jnagy@isd191.org.

This institution is an equal opportunity provider.
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Reason for Home Delivery *
Parent/Guardian First and Last Name *
Address (including any Apt number) *
City *
Name of Apartment Complex, Mobile Home Community, etc. if applicable
Phone *
Email
Which of the following schools is the closest to your home? *
Total Number of Children Ages 1-18 *
Student 1 Name *
Student 2 Name
Leave blank if none.
Student 3 Name
Leave blank if none.
Student 4 Name
Leave blank if none.
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