Food Backpacks 4 Kids Enrollment Form

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Use this form to enroll Peninsula School District & Homeschool students within PSD boundaries in the Food Backpacks for kids program.

Student Last Name *

Student First Name *

Gender *

Male

Female

Required

Race / Ethnicity

Grade *

Any Allergies? *

None

Peanuts

Gluten

Other:

School *

Teacher *

How many infants are in your home - ages 0 to 2? *

How many children are in your home - ages 3 to 18? *

How many adults are in your home ages 19 to 54? *

How many adults are in your home age 55 and up? *

Would you like a crock pot? *

Yes

Parent / Guardian Name *

Parent / Guardian Email *

Parent / Guardian Cell Phone

Submit

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