2021 Summer Meal Request Form

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TO BE FILLED OUT ONCE PER FAMILY OR HOUSEHOLD GROUP!

Contact information:

Kathy Glennie
kitchen@w-harrison.k12.ia.us
712-646-2231, ext. 109

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電子郵件 *

Information

Telephone Number & Guardian Name /Who you are requesting meals for and age/grade?

Address

PICK UP-- what location

Please indicate how you would like to receive the meals:

Pickup (see flyer for locations)

Delivery

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If "Delivery" was selected, what address will these meal be delivered to?

Please read and check all the boxes below to show that you have read, understand, and will follow our expectations for the West Harrison Summer Meal Program: *

Pickup time is on Wednesdays, from 10 am - 10:30 am during June and July. Failure to pickup or be present for deliveries will result in the termination of this service.

If necessary, I will contact the school (Kathy Glennie) and arrange for another pickup time at the school. I understand that this cannot take place on a regular basis.

I will contact the school (Kathy Glennie) by Monday if meals are not needed for that week.

I will contact the school (Kathy Glennie) if I wish to terminate the Summer Meal Program for my child(ren).

I understand the school may choose to not deliver if necessary, due to unsafe conditions (i.e. animals).

必填

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