Seamless Summer Parent Request and Consent Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out one form for your household and return to Melbourne Schools by Tuesday, April 23, 2024 if you would like to receive meals for your children (ages 1-18) starting June 3rd. The last delivery or pick up will be on July 29th.

Are you the parent or guardian of a student enrolled in the Melbourne School District? *

Yes

Which bus route serves your area? (if known) *

Bear Bus (Melbourne City Limits area)

Bird Bus (Zion, J Bar J road, Franny Lankford road area)

Bull Bus (Guion, Gid, West road, Stella Loop area)

Chick Bus (Violet Hill, Franklin, Wiseman Horseshoe Bend area)

Dog Bus (Hwy 9 south, Mt Olive Road area)

Donkey Bus (Hwy 69 south , Mt Pleasant to Cushman store)

Fish Bus (Bonetown, Antioch road, Sage)

Frog Bus (Knobcreek Road, Newburg Rd, Page Cemetery Rd area)

Horse Bus (Hwy 9 North to Oxford area)

Monkey Bus (Barrenfork road, Hwy 58 west area)

Pig Bus (Jumbo road, Lunenburg road area)

I do not know which bus serves my area.

How many children live in your household aged 1-18 *

List the names and ages of each child aged 1-18 *

Preferred method of delivery *

Parent will pick up at Melbourne Elementary School (recommended)

Home Delivery

Parent/Guardian Name *

Physical Address *

Phone number *

Parent/Guardian Signature below gives consent for meal delivery to the home address of child or children listed above. *

Today's Date: *

Complete for Home Delivery:

Directions to your home for the delivery person *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Melbourne School District. Report Abuse

Forms