Summer Meal Participation Survey
Dear Parent/Guardian:

PLEASE READ CAREFULLY!   New Hampton Community Schools will be participating in the Summer Food Program through the month of June.  We will be handing out free grab & go meals on Tuesdays and Thursdays beginning June 2nd.  The last day for pick up will be Tuesday June 28th.   This will include meals through June 30th.   If you pick up on both pickup days, each child will have received a TOTAL of 5 days worth of breakfast and lunch and 1 gallon of milk.  You can sign up by filling out the form online (check your email), by calling and speaking with our Director of Food Service, Jodi Cerwinske at 641-394-2134 ext. 1120, emailing her at j_cerwinske@new-hampton.k12.ia.us or by filling out and returning a paper copy of this form.

Our plan is to provide precooked meals, where some of the items will require reheating.  After you have picked up your meals, remove any shelf stable items such chips or cereal.  If you are not going to heat items immediately to eat, please refrigerate or freeze items.  To heat items, remove them from their transport containers and place in a microwave or oven save container and heat thoroughly.  Each child is allowed 1 gallon of milk per week.  Milk will be handed out on Tuesdays ONLY.   This can be a lot of milk for families with multiple children.  If you do not have room to refrigerate multiple gallons, please indicate below, on question #5 how many gallons you would like to pick up on Tuesdays.  Since we are starting service on Thursday June 2nd, you will receive your milk for the week this day instead.  It will be on Tuesdays only after that.

If you are unable to pick up your meals or change your mind about wanting the meals please contact our Director of Food Service, Jodi Cerwinske by calling 641-394-2134 ext. 1120 or by email at j_cerwinske@new-hampton.k12.ia.us 

Email *
Child/Children's Names who want to receive meals (First and Last Name) *
Parent Name (First and Last Name) *
Contact Phone Number *
Choose a Location to Pick Up Meals *
Due to Federal guidelines, meal pick up sites will only be at these 3 locations: Runion Park (across form St. Joe’s Catholic Church), Immaculate Conception Church in North Washington, and the Alta Vista City Parking Lot.  Parents will need to sign up their children to participate.  This program is open to all children ages 1-18.  If you have any questions, please contact our Director of Food Service, Jodi Cerwinske by email at j_cerwinske@new-hampton.k12.ia.us or by phone at (641) 394-2134 ext.
Required
Do you want Milk? *
If Answered YES to (Do you want Milk?) Each child is allowed 1 gallon of milk? *
Any special dietary needs or allergies? *
If you know you will ONLY be picking up on Tuesday, please check the box
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of New Hampton Community Schools. Report Abuse