2022-2023 Booster Pak Sign-Up
In addition to the many programs offered by the West Des Moines Community Schools, Booster Pak is a non-profit organization that has partnered with the school district to help reach those students and their families who may need additional food assistance on the weekends. Our programs are free and confidential to the students and families who participate. If this is something that you think would benefit your student(s), please fill out this sign-up form. Once we have received your information, we will have your students school contact you. 
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Parent Name *
Parent Phone Number *
Parent Email *
Student Name (1) *
Student Grade (1) *
Student School (1) *
Student (1) - Elementary Teacher's Name (Pk - 6th only)
Student Name (2)
Student Grade (2)
Clear selection
Student School (2)
Clear selection
Student (2) - Elementary Teacher's Name (Pk - 6th only)
Student Name (3)
Student Grade (3)
Clear selection
Student School (3)
Clear selection
Student (3) - Elementary Teacher's Name (Pk - 6th only)
Student Name (4)
Student Grade (4)
Clear selection
Student School (4)
Clear selection
Student (4) - Elementary Teacher's Name (Pk - 6th only)
Student Name (5)
Student Grade (5)
Clear selection
Student School (5)
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Student (5) - Elementary Teacher's Name (Pk - 6th only)
Do you have additional children enrolled in WDM Schools?  Check "Yes" and someone will contact you *
Food Allergies - By checking this box, I understand that food items may include ingredients such as tree nuts, soy, wheat, gluten, eggs, milk and other potential allergens. It is the responsibility of parents/guardians to ensure the food items are suitable for their student(s). The Food Bank of Iowa, WDM Schools and Booster Pak do not assume any liability for adverse reactions to food handled and/or consumed. *
Required
Liability - By checking this box, I agree to assume any and all risks and release the Food Bank of Iowa, WDM Schools and Booster Pak from any and all liability associated with my student's participation in the Pack or Pantry programs, including any adverse reaction my student(s) may have to foods handled and/or consumed. *
Required
Participation/Acknowledgment - By checking this box, I agree to allow my student(s) to participate in the Booster Pak or Pantry Programs. I hereby acknowledge that I have read this entire document, that I understand it's terms and that I agree to participate knowingly and voluntarily. *
Required
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