Summer Feeding 2021
This form allows the parent/guardian to request breakfast and lunch for their children who are not attending Summer Academy through the school or Summer Recreation through the village.  Children who are attending Summer Academy and Summer Recreation will be provided meals while attending those programs.  The program runs from July 6, 2021 through August 18, 2021.  Pickups will occur on Mondays and Wednesdays (except for week 1), from 9:30-10:30am at the Elementary School office.  Planned absences from the program should be noted.  Eligible children are as follows: any child in the household from birth to age 18.  
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Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email Address
Child #1 Name *
Child #2 Name
Child #3 Name
Child #4 Name
Child #5 Name
What weeks will you NOT participate?  (planned vacation, etc)
Please add any necessary comments or concerns you may have (allergens or dietary restrictions).  We will reach out to you via phone or email.
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