Food Support Request
Please fill out and submit this form if you and/or your family have food needs for the 2021-22 school year.
Our current food supports include monthly grocery gift cards and local pantry deliveries to your home.
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Parent/Guardian First & Last Name
Please provide your CHS student name(s) and grade(s). Ex: John Doe, 10th Grade
Please provide the best cell or home number to reach you.
Please provide your street address and apartment # if applicable, where we will make our deliveries.
Please share any additional details/requests (where to leave food, etc).
What food assistance do you need? (You may request both.)
Weekly food deliveries
Grocery gift cards (these will be mailed to you monthly)
Do you agree to share your name and address with a Cougar Cares volunteer for purposes of delivering food to your home? You can withdraw at any time by contacting Arelis Tapia at the Parenting Center at (973) 750-4759 or 973 762-5600 Ext.: 1850
Do you have food allergies in your household?
If yes, please describe
Do you agree that, although the volunteers will try to abide by all allergy restrictions, it is your responsibility to check ingredients in all food delivered to you?
Sign as an acknowledgement of request and of completing form. Thank you.
A copy of your responses will be emailed to the address you provided.
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