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Student Feeding Program
Please provide the following information in the event that schools are closed for a significant period of time resulting in delivery of breakfast and lunch items to students' homes.
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Student First Name
*
Your answer
Student Last Name
*
Your answer
Please provide the names of other students in the home
Your answer
Parent Name
*
Your answer
Please list the preferred address for delivery of food.
*
Your answer
Please provide the best phone number to contact the parent/guardian.
*
Your answer
How many children (18 and under) are in the household and would need meal delivery?
*
Your answer
Additional Comments
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