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Summer 2021 Student Signup
Blessings in a Backpack will be delivering bags of food every three weeks this summer. If you would like to have us deliver to you, please fill in the form.
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* Indicates required question
Parent/Guardian Email:
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Your answer
Parent First Name:
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Your answer
Parent Last Name:
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Your answer
One request per household. How many children can we provide food for?
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1
2
3
4
Other
Please list children names:
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Your answer
Address for delivery:
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Your answer
Allergies:
*
Nuts - any/all kinds
Dairy/lactose
None
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