2023-24 Backpack Program Enrollment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Backpack Program is for children who may need help supplementing food while not in school. They will receive a bag/backpack with a supply of non-perishable food for the weekends or vacations to help supplement with meals.

Family's that sign up will be given ONE labeled reusable bag that will be for all the children in the family. Parent/guardians decide which child will be responsible for the bag and that child will get the bag delivered to their classroom each Friday. In order to continue to get the bag each week, students will need to return the bag to school before Friday. It will then be filled and returned to them on Friday for the next week. If the bag is not returned, they will not receive a bag for that weekend/vacation.

In order for participation in the program to occur, we need the parental consent form below to be filled out and submitted.
If you have questions about this program, please call Michelle Dye or Trisha Kling at 625-5222. You may also reach out to the building secretary if needed.

This form ONLY needs to be filled out ONCE per family/household.

How many total children are in your household?

Student Name *

Please ONLY list the name of the student who will be responsible for bringing the bag home.

What is the grade of the student who will be bringing home the bag? *

ELEMENTARY ONLY... What is the name of the student's homeroom/classroom teacher? (only for the student bringing the bag home)

Any know food allergies? *

Parent's Name *

I understand that in order to continue to receive the bag filled each week, we will need to return the assigned reusable bag before Friday. If they bag is not returned, we will not receive a bag of food for that weekend/vacation.
*

If the bag is lost or ruined, please contact Trisha Kling or Michelle Dye so you can still continue to receive food each week.

I have read and understand that we must return the assigned food bag to continue to receive food.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Altmar Parish Williamstown Central School District. Report Abuse

Forms