Feeding Children Survey

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We are awaiting notification from the state as to whether we are authorized to provide free breakfast and lunch to children off campus. In preparation for that decision and to help with planning, we are asking that each family complete this survey as soon as possible. Only one person per household is needed to take this survey. IF YOUR FAMILY IS NOT IN NEED OF MEALS OR YOU ARE NOT WILLING TO VOLUNTEER THERE IS NO NEED TO COMPLETE THIS SURVEY.

Name of person completing the survey: *

Address of person completing the survey: *

Contact information of a family member completing survey: *

Number of children to be fed: *

If you are able to pick up at the school, which of the following times are you available? (Check all that apply) *

7:00 a.m. - 8:00 a.m.

8:00 a.m. - 9:00 a.m.

9:00 - 10:00 a.m.

No, we are unavailable

I don't need meals

Required

If you are not available , would you be willing to have meals delivered to your home? *

Yes

Not necessary, we can pick up meals

I don't need meals

Are you or someone you know willing to volunteer with the delivery of meals?

Yes

Clear selection

If yes, please provide the name and contact information of the willing volunteer(s).

Submit

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