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Parent Nutrition Program
Please fill out the following survey if you would like to participate in the district's delivery/pickup nutrition program between Monday, March 25 and Wednesday, April 8. The deadline for completing the survey is 3:00 PM on Monday, March 23.
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* Indicates required question
Email
*
Your email
Parent Name
*
Your answer
Address (Delivery will only be made to this address for families not living in town and not having transportation.)
*
Your answer
Parent Telephone Number
*
Your answer
Number of Meals Needed
*
Your answer
Children's Names and Grade Level
*
Your answer
Pickup Location
*
Kalona Mennonite Church Parking Lot
Grass Lot East of Kalona Chamber Building
Wellman Mennonite Church Parking Lot
Wellman First Baptist Church Parking Lot
West Chester Heritage Building (former West Chester School)
Home School Education Center Parking Lot (former Washington Township Elementary)
Delivery to Address Above
If you selected "Delivery to Address Above" please type your name in the space below as a signature acknowledging you agree to meal delivery at your home.
Your answer
A copy of your responses will be emailed to the address you provided.
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