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Summer Food Site Registration
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Is this an update to an existing site that is already visible on the map, or a new site that needs added to the map?
New site - Not on the map yet
Existing Site - Already visible on the map
Site Removal - Take a location off of the map
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Nutrition Site Name/ Sponsor Organization
Your answer
Location Type
Bureau for Senior Services Nutrition Site
Summer Food Service Program
Food Pantry
Community/Non-Profit Feeding Site
Location Street Address Line 1
Your answer
Location Street Address Line 2
Your answer
City
Your answer
County
Choose
Barbour
Berkeley
Boone
Braxton
Brooke
Cabell
Calhoun
Clay
Doddridge
Fayette
Gilmer
Grant
Greenbrier
Hampshire
Hancock
Hardy
Harrison
Jackson
Jefferson
Kanawha
Lewis
Lincoln
Logan
Marion
Marshall
Mason
McDowell
Mercer
Mineral
Mingo
Monongalia
Monroe
Morgan
Nicholas
Ohio
Pendleton
Pleasants
Pocahontas
Preston
Putnam
Raleigh
Randolph
Ritchie
Roane
Summers
Taylor
Tucker
Tyler
Upshur
Wayne
Webster
Wetzel
Wirt
Wood
Wyoming
Zip
Your answer
Phone Number
Your answer
Website URL
Your answer
Population Served
Seniors age 60 or older
Spouses of a seniors 60
Disabled individuals in household of senior 60 or older
Children or grandchildren living with a senior 60 or older
Children 18 and under
Homeless
Other:
Start Date for Summer Feeding Program (mm/dd/yyyy)
MM
/
DD
/
YYYY
Ongoing Program
Yes
No
End Date for Summer Feeding Program (mm/dd/yyyy)
MM
/
DD
/
YYYY
Ongoing Program
Yes
No
Pick-up days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Pick-up hours (Start)
Time
:
AM
PM
Pick-up hours (End)
Time
:
AM
PM
Meal Type
Shelf-stable meal
Hot meal
Perishable groceries
Grocery shopping assistance
Appointment Required
Yes
No
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Curb-Side Pickup
Yes
No
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Quantities
30-day pack
7-day pack
5-day pack
3-day pack
2-day pack
Daily Meal Service
Registration Required
No ID required, but participant must provide name, address, phone number and DOB for all household
ID required
No ID or information required
Comments
Is there anything else you’d for us to know about your nutrition site?
Your answer
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