Bags of Hope - Permission Form

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Dear Parents and Caregivers,

We are very fortunate to have several community organizations that offer their time and resources to our students. Bags of Hope has partnered with our school to provide food for families in challenging financial situations and are in need of food assistance.

Bags of Hope provides a backpack filled with easy-to-use foods for your child to help stretch your food budget dollars on weekends. This backpack of food will be provided at no cost to your family. Your student is invited to participate in this program.

Please understand your student's school, the local school system, and Bags of Hope are not liable in any way for any damages or injuries which may occur. If you agree to participate in the Bags of Hope program, you, as the parent/guardian, assume full responsibility for any damage or personal injury. You also assume full responsibility to ensure there are no items in each bag to which your student may be allergic.

If you are interested in participating, please complete the form below. The information you are providing is for record keeping purposes only and will only be shared between Bags of Hope and your school's Bags of Hope coordinators.

Email *

School Name *

Student Name - First Name *

Student Name - Last Name *

Phone Number: *

Student Grade Level (2022-2023 school year) *

List Any Food Allergies *

Parent Name *

Please read all statements and check all boxes below to indicate you accept the guidelines of the Bags of Hope program. By checking these boxes you are giving permission for your student to receive weekly bags of food. *

YES, we understand the expectations for this program and my student has permission to receive a weekend backpack.

YES, we understand that my student's school, the school system, and Bags of Hope are not liable in any way for any damages or injuries which may occur. I/We assume full responsibility for any damage or personal injury.

YES, we understand that we are responsible for checking each bag to make sure there are no foods to which my child is allergic.

YES, we understand that the backpack provided by Bags of Hope is to be returned each week for food, and then again at the end of the school year.

YES, we understand that by agreeing to participate in the Bags of Hope program, we commit to do our best to follow the designated pick-up procedures for my school weekly. If I have issues with pick-up, I understand I am responsible for contacting my school representative.

YES, we understand it is our responsibility to pick up our student's food and if we fail to pick up the weekly bags of food more than 4 times during the school year we are forfeiting the opportunity to receive food and our student will be removed from the program.

NO, my student does not have permission to participate.

Required

Parent's or Guardian's Signature (please type your name to indicate a digital signature) *

Student's Signature (if 18 or older - please type your name to indicate a digital signature)

A copy of your responses will be emailed to the address you provided.

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