(Summer)Viroqua Area Schools Meals Program

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Viroqua Area School District is providing meals for families that would like to participate. ALL children 18 years and younger who live in our District are eligible for breakfast and lunch each day at no cost. There are no income-based qualifications needed to participate. This program is also available to private school and home-schooled children. We anticipate that this program will continue until August 7.

If you have not already signed up and want to participate and receive meals, you will need to complete this form so we can begin preparing and organizing our meal program for you.

* Please do not complete this form more than one time for your family. If you have a change or have any questions, please contact us by phone or email.
bvold@viroquablackhawk.org or 608-637-1181
ethkri@viroquablackhawk.org or 608-637-1645

• Meals will be provided Monday - Friday.

• When you submit this form you will receive a message that says, "We've received your response. We will contact you by phone or email to confirm when delivery will begin."

Responses received by 3:00 pm will likely receive meals the following day. We will contact you to confirm when delivery will begin.

If you need assistance completing this form or have questions about this program, please call 637-1181 or 637-1645. You may also reach us at bvold@viroquablackhawk.org or ethkri@viroquablackhawk.org

Email *

Do you want to participate and receive meals *

YES, please include my family in the meals service. I will complete the information below. If not, please close this form.

Required

Please enter your first and last name (as the responsible adult) *

Please add the best phone number to contact you. *

Please tell us how many children 18 years old or younger that you are requesting free breakfast and lunch for.

List the names for children receiving meals.

Are there any adults that would like to purchase meals for (breakfast and lunch) at the rate of $7.00 per day to be paid upon delivery each day?

No thank you

Yes

Clear selection

If yes, how many adult meal packages at $7.00 per day are you requesting?

Please list any allergy requirements that we need to be aware of.

We plan to deliver meals approx. 10:00-12:00 each day along regular bus routes. Pick-up locations will be available from 11:30-12:00. We need to know for planning purposes where we can deliver your meals. Please choose the best answer.

Please deliver to my child's regular bus stop

I would like to pick up our meals at my child's city bus stop or a location near the school if my child doesn't ride a bus..

Neither option will work, please contact me.

Clear selection

Please tell us your address.

If your child rides a regular bus route please tell us your the bus number (if you know it).

If your child does not ride a regular bus route, you may select their city stop or a pick-up location below.

Abbey Ln (Corner of Camelot & Williams)

English Lutheran Church Lot

Bethel Home (Corner of Garfield & Maple)

Pleasant Ridge School ( on East Court St.)

None of these options will work, please contact me.

Clear selection

Thank you for your participation and completing this form. Please add any additional notes that you feel we may need to help you with our meals program. We hope that we can help you and your family stay healthy and safe during these difficult times. Sincerely, Dr. Kehl Arnson

A copy of your responses will be emailed to the address you provided.

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