TANAGER TAKE-OUT & WEEKEND BACKPACK REGISTRATION

Vermillion School District Food Programs are for households with students (Head Start through Grade 12) enrolled in Vermillion School District.

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Email *
Households may register for either Tanager Take-Out OR Vermillion Weekend Backpack Program. Please choose one below.
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PARENT/GUARDIAN FIRST NAME *
PARENT/GUARDIAN LAST NAME
 *
STREET ADDRESS *
CITY & STATE *
PHONE NUMBER *
How many students are you enrolling in a Vermillion School Food Program? *

I understand that all information gathered about me is personal and private and that the Community Connection Center agencies will not share my private information.  

If this application leads to assistance, I understand that false or misleading information may result in assistance being denied.  

 *
Required
STUDENT 1: FIRST & LAST NAME

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STUDENT 1: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
 *
STUDENT 2: FIRST & LAST NAME
STUDENT 2: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 3: FIRST & LAST NAME
STUDENT 3: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 4: FIRST & LAST NAME
STUDENT 4:  SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 5:  FIRST & LAST NAME
STUDENT 5: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 6: FIRST & LAST NAME
STUDENT 6: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 7: FIRST & LAST NAME
STUDENT 7: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
STUDENT 8: FIRST & LAST NAME
STUDENT 8: SCHOOL, GRADE & TEACHER  
(Example: Jolley 5th Mr. Mart)
A copy of your responses will be emailed to the address you provided.
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