Request edit access
Jersey Shore BackPack Program
The JSASD, The New Love Center, and the Central Pennsylvania Food Bank have once again teamed up to pass out "backpacks" to students.  Any student in the district qualifies for this program.  The backpacks will be passed out on Fridays and will consist of healthy snacks and single serve meal options to take home for the weekend.  Please fill out a form for each student you have in the district.
Sign in to Google to save your progress. Learn more
Student's Name *
Student's Age *
Student's Grade *
Student's Homeroom Teacher *
Student's School *
By signing this form, I agree to allow my child to participate in BackPack, a program of the Central Pennsylvania Food Bank and the host site. I understand that, for children with food allergies, BackPack items may contain possible allergen-containing ingredients. Parents and guardians concerned about food allergies need to be aware of this risk. The Central Pennsylvania FoodBank and host site will not assume any liability for adverse reactions to food consumed. By signing this form, I agree to assume any and all risks associated with my child’s participation in the BackPack Program, including any adverse reaction my child may have to food consumed. *
Required
Guardian's Name *
Relationship To Student *
Phone Number *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy