RBMS Snack Pack Form Spring 2023
Dear Parents,
The Samaritan Community Center is partnering with schools to provide sacks of food to eligible children on a weekly basis through the Snack Pack for Kids Program. The program will provide 8-10 food items to students each Friday afternoon so they will have food available for the weekend.

The following is a list of foods that will usually be provided: Shelf Stable 1% Milk, Fruit Cups, Pudding Cups, Fruit Snacks, Cereal, Slim Jim, Cheese and Crackers, Easy Mac, Ramen Noodles, Shortbread Cookies, and Apple Sauce.

If you would like for your child to participate in this program, please complete the information below. Due to the limited number of snack packs, priority will go to those with the highest need.  

If you have any questions, please contact LaShey Sisemore lsisemore@bentonvillek12.org or Cassie Hamaker chamaker@bentonvillek12.org ---RBMS School Counselors.
Email *
1. The undersigned parent or legal guardian agrees to allow my child or children to participate in the Snack Pack for Kids Program. I have read the list of food items shown above and have no objection to Snack Packs for Kids providing these or similar food items to my child to take home on the weekends. By clicking YES I am signing and giving my permission. *
2. Student's Name *
3. Student's Grade *
Required
4. Homeroom Teacher? *
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