IMPORTANT: Summer Feeding Survey

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Please fill out this survey so we have an idea of what summer meal option you would like for your child this summer. Food will be available for delivery or pickup on May 31st, June 7th, June 14th, June 21st, June 28th, , July 12th and July 19st and July 26th . There will not be food delivery July 5th. Call Food Service Director Amy Hollan at 606-666-5164 for more information.

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Do You plan on participating in JCS Summer Feed Program? Options will be meal pick up at JCS or delivery along the site route. *

yes

Parent/Guardian Name *

Parent or Guardian Phone Number *

What School do your children attend? *

List household members 18 and younger including age. (Example: Johnny, 10 Haley, 6 Peggy, 8 months). Include children you babysit. *

Choose from the following options: *

Thursday Riverside Pick up Noon

Friday delivery of meals for the entire week, along the site route:

Friday meal pick up for the week at the school , beginning at 9:00 AM to 1:00pm

I am unable to pick up the food. I give the following person permission to pick up the meals. Please include: Name and phone number. *

If meal delivery is needed, provide the delivery pick up site: *

I will pick up a JSC / no delivery needed

Ivy Court Apartments

Sazon

Clairs Trailer Court

Family Practice Physicians/ Ky River Clinic

Cherokee Trailer court( By Hospital)

Walmart Parking Lot

Delhi Apartments

Shucky Bean Hollow

Ace Hardware Parking Lot

Tim Jones Trailer Court

Riverside parking lot at Thursday at noon

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