Breakfast & Lunch Request Form
The Julesburg School District is planning to continue our COVID-19 emergency free food service through August 28, 2020. This is available to any child ages 1 through 18 years of age. You do not need to qualify for free or reduced meals to utilize this service. This will continue to be a Grab-n-Go Style; Lunch & Breakfast (for the next morning) will be picked up at the elementary school from 11:45 a.m. - 12:15 p.m. daily (Monday - Friday). Food will be distributed on a first come first serve basis. Please fill out this survey if you plan to utilize this emergency food service. You do NOT need to fill this survey out again if you have already done so for June and/or July.
Student(s) Name(s) and Grade(s): (i.e. Mary Smith, 4th Grade) (List all of your children who will need food service): *
By typing in my electronic signature, I will participate in the extended district breakfast and lunch program Monday through Friday (school days) AND I will pick up my child(ren)'s food at the elementary school between 11:45 a.m. and 12:15 p.m. daily. *
Never submit passwords through Google Forms.
This form was created inside of