Chillicothe R-II Free Meal Request Form
Please fill out this form (one time) if you are requesting district-provided meals from the dates March 18-April 3rd. The current day's lunch and the next day's breakfast will be available daily Monday-Friday. These are available to any person 18 years and under residing in the Chillicothe R-II School District. This program is run in cooperation with the Department of Health and Senior Services. *Disclaimer these meals are not regulated by dietary restrictions. i.e. gluten-free, nut-free
Name of person requesting meals.
Contact Information (phone number)
Address (Include street address and city)
The total number of student meals requested per day.
Pick up or Delivery
Delivery (for those without transportation)
Chillicothe Middle School
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This form was created inside of Chillicothe R-II School District.