Emergency Food Distribution Request
If you have previously registered, please DO NOT submit this form again.

As we all continue to prepare and adapt to the, sometimes hourly, changes and guidance regarding the
COVID-19 Virus, we would like to gather information from families that may need for assistance with meals
during a school closure. If you feel that you would fall in this category, please fill out this
form as soon as possible.
Email address *
Please select one *
Required
Parent / Guardian First and Last Name *
Your answer
Student First and Last Name(s) *
Your answer
Any Food Allergies *
If the answer above is Yes, please describe the allergy
Your answer
Full Address to be used for delivery *
Your answer
Primary Telephone Number *
Your answer
Is the number above a cell phone number? *
Required
Secondary Phone Number
Your answer
Secondary Email Address
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of West Genesee Central School District. Report Abuse