Dilworth Backpack Initiative Sign-up Form
Dear Dilworth Parents & Guardians,

In November 2014, Pittsburgh Dilworth’s PTA began an in-house Backpack Initiative; its mission is to assist Pittsburgh Dilworth pre K-5th grade students experiencing food insecurity by providing weekend food supplies.  Each student participating in this program receives a bag packed with child-friendly single-serving snacks and easily prepared meals on Friday. The food is donated, packed, and distributed by Dilworth volunteers and community partners. We strive to include protein, whole grains, fruits, and dairy products. Please note that weekly item distribution is dependent on supply availability.  *Peanut products will be sent home.*

In order to enroll in this program, please complete the permission slip below.  If you are enrolling more than one student in the program, please complete a separate form for each student.  If, at any time, your situation and needs change, please contact your child’s homeroom teacher so that we may adjust our distribution.  

For more information about the Backpack Initiative, including how to make a donation or help with bag packing and distribution, please contact Julie Frischkorn at dtabackpacks@gmail.com.  

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Backpack Initiative Enrollment *
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Child’s name *
Child's Homeroom *
Child's Grade *
Parent/Guardian Email (if available)
Parent/Guardian Phone *
Text Messages OK? *
Parent/Guardian’s Name *
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