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Coppell Cares Sack Summer Hunger Program
SACK SUMMER HUNGER APPLICATION - For more information about Sack Summer Hunger visit
Metrocrest Social Services - Program Runs May 23 – August 8, 2020 - Food Delivered Weekly
FORM DUE BY MAY 15, 2020
"SACK SUMMER HUNGER" APLICACION - Para más información sobre el programa de Sack Summer
Hunger, visite Metrocrest Social Services - Programa Disponible 23 de mayo – 8 de agosto, 2020 - La
comida se entrega cada semana
FORMULARIO para el 15 de mayo, 2020
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Email
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Your email
School Name/Nombre de la Escuela:
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Your answer
District/Distrito:
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Your answer
Parent Name (Last, first, middle initial)/Nombre del padre o de la madre (apellido, primer nombre, segundo):
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Your answer
Parent Date of Birth/Fecha de nacimiento del padre o de la madre:
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MM
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DD
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YYYY
Address (Street, City, Zip Code)/Direccion (Calle, Ciudad, Codigo postal):
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Your answer
Telephone Number (Daytime)/Telefono (Dia):
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Your answer
Telephone Number (Nighttime)/Telefono (Noche):
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Your answer
Email Address/Direccion de E-mail:
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Your answer
Does your child participate in the free or reduced lunch p?/¿Participo su hijo en el programa de almuerzo libre o rebajado?
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Yes
No
Have you received services from Metrocrest or Coppell Cares Services before?/¿Ha recibido ud. antes, los servicios de Metrocrest o Coppell Cares? ?
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Yes
No
Please list all children 18 years old or younger living in your household (name, age, grade, school, allergies)./ Por favor, enumere todos los hijos de 18 años o meno que viven en su casa (nobre de hijo o hija, edad, grado, escuela, alergias).
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Your answer
I certify that my family would like to participate in the Sack Summer Hunger Program. If my child is allergic to any products, I realize it is my responsibility to prevent him/her from eating those products. In accepting this assistance through Metrocrest Services, I give consent for this declaration to be correlated with all participating agencies in order to assure the most effective use of available funds and delivery of food. / Yo certifico que a mi familia le gustaría participar en el programa de Sack Summer Hunger. Si mi hijo tiene alergia a cualquier producto, me doy cuenta de que es mi responsibilidad dejarlo-la de comer esos productos. Con aceptar esta ayuda de Metrocrest Services, permito que esta declaración esté de acuerdo con todas las agencias para asegurar el uso más efectivo de los fondos disponibles y el entrego de la comida.
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Yes
No
Electronic signature of parent or name of person completing this form for parent/Firma electrónica del padre o madre o Nombre de la persona que completa el formulario para el padre
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Your answer
Date/Fecha
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DD
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