Backpack Program Registration Form

Dear Parent/Guardian

Your child has been invited to participate in the backpack program. This program is free of charge thanks to our partnership with the Child Hunger Outreach Partners (CHOP). Every week, your child will be provided with a bag of nutritious, non-perishable food that is to be eaten over the course of the weekend. It is not intended to be opened until your child is home. The program will continue throughout the school year. As this food is sourced from the charitable food network, some items may be at or slightly past it's best by date. All items are safe for consumption per USDA guidelines.

To enroll your child in this free program, please complete this form and return it to your child's teacher. Feel free to email Larissa at CHOP (Larissa@chopouthunger.org) with any questions. 

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Student Last Name *
Student First Name *
Teachers name *
Grade *
Age *

By signing this form, I agree to allow my child to participate in the backpack program of Child Hunger Outreach Partners. 

I understand that the bag may contain allergen-containing ingredients and am aware and responsible for the risks associated. The school district and Child Hunger Outreach Partners will NOT assume any liability for adverse reactions to foods consumed. By signing this form, I agree to assume any and all risks associated with my child's participation in the program, including any adverse reactions my child may have to foods consumed. 

(you're typed name is a valid signature)

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CHOP PHOTO USE RELEASE FORM 

I, hereby grant and authorize Child Hunger Outreach Partners the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me or my child by Child Hunger Outreach Partners to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Child Hunger Outreach Partners and will not be returned. I hereby hold harmless, and release Child Hunger Outreach Partners from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate. 


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