Summer Lunch Box Family Registration 2023

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Please complete all fields and submit. PLEASE MAKE A NOTE OF PICK-UP DATES AND TIMES FOR YOUR LOCATIONS. IF YOU ARE NOT PICKING UP A CERTAIN WEEK, YOU MUST LET US KNOW. FAILURE TO SHOW FOR PICK UP TWO (2) TIMES RESULT IN BEING REMOVED FROM THE PROGRAM. By submitting your registration, you agree to these terms.

Email *

Last Name - list the LAST NAME of the head of household/who will be picking up the order *

First Name (list First name(s) of those in the household who will be picking up the order) *

Phone Number- YOU MUST include a number where you can be reached! *

Is this a Cell number where you can receive texts? *

Yes

Address: *

Number of children in the family (this program is for school-aged children up to age 18) : *

Select your school district and pick-up location *

A - Elk Lake School District - Elk Lake High School pick up

B - Montrose, Neuman Center - Choconut pick up

C - Montrose - Interfaith, Montrose pick up

D - Mountain View School District - Master's Concrete Building (Rte 11 -next to Picadilly)

E- Blue Ridge School District - Master's Concrete Building (Rte 11 - next to Picadilly)

Ages of children, separated by a comma: *

List any food allergies: *

Provide any other information:

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