School Meal Request for Virtual Early Childhood Programs
Please fill out the following form regarding school meals for children enrolled in the Early Childhood Virtual Learning Program. Even if you do not wish to receive meals, you need to fill out this form.  DEADLINE FOR FORM SUBMISSION IS MONDAY, AUGUST 10TH!

Meals need to be picked up every Sunday from 2:00-4:00 pm. Children in the Brusly area will pickup at Brusly Middle School and children in the Caneview/Port Allen area will pickup at Port Allen High School.  

You must fill out a separate form for each child that you have enrolled.

This institution is an equal opportunity provider.
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Child's First Name *
Child's Last Name *
School *
Choose 1- I would prefer *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Email Address *
Parent/Guardian's Street Address *
Parent/Guardian's Zip Code *
Parent/Guardian's Phone # *
Does your child have any dietary restrictions? *
If you answered yes to dietary restrictions, please explain and submit a Diet Prescription Form completed by your child's pediatrician to your child's school.  
Do you consent to the following; By consenting you agree to: meal pick-up and meal received is solely for the child listed above.   *
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