Stored Goodness Summer Feeding & Learning Program Registration - Interest Form

Stored Goodness Summer Feeding & Learning Program

We are excited to offer a structured summer program for youth ages 5–12, combining free meals with engaging educational and skill-building activities in a safe and supportive environment.

Teen Leadership Opportunity:
In addition to youth enrollment, we are offering a limited number of Junior Leader positions for teens ages 13–17. Junior Leaders will support program activities, assist with younger participants, and gain valuable leadership and hands-on experience throughout the summer.

If you have a teen interested, you will have the opportunity to indicate that later in this form.

Please Note:
This is a limited-capacity program (25–50 students).Submitting this form lets us know you are interested in participating.

All families who apply will be contacted directly with an update on their status and next steps prior to the program start date.

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Email *
 SECTION 1: PROGRAM ELIGIBILITY
1. Is your child between the ages of 5–12? *
Are you registering additional children?
Clear selection
How many total children are you registering for this program?
Would you like your children to be placed in the same group (if applicable)?
Clear selection
 SECTION 2 :CHILD INFORMATION
2. Child’s Full Name *
3. Child’s Age (as of June 1st, 2025) *
4. Date of Birth *
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5. Grade (Entering in the 2025–2026 School Year) *
6. School Attending (2025-2026 School Year)
 SECTION 3: PARENT / GUARDIAN INFORMATION
7. Parent/Guardian Full Name *
8. Phone Number *
9. Email Address *
10. Home Address (Street, City, State, Zip) *
11. Emergency Contact Name & Phone Number (Other than Parent/Guardian) *
 SECTION 4: HOUSEHOLD INFORMATION 
12. How many children (under 18) are currently in your household?
Clear selection
13. Do you have reliable transportation to and from the program site?
Clear selection
 SECTION 5: PARTICIPATION DETAILS
14. How often do you plan for your child to attend? (Program runs Tuesday–Thursday) *
15. When would you like your child to start the program? *
If you chose 'Later' for Question 15, please specify the date or reason.
 SECTION 6: HEALTH & SAFETY 
16. Does your child have any known allergies? (e.g., peanuts, bee stings, dairy. If none, write 'None') *
17. Does your child have any medical conditions we should be aware of? (e.g., asthma, diabetes, seizures. If none, write 'None') *
18. Does your child have any dietary restrictions? (e.g., vegetarian, gluten-free, no pork. If none, write 'None') *
 SECTION 7: PROGRAM ENGAGEMENT
19. What specific skills or subjects would you like your child to learn or focus on this summer? (e.g., Reading comprehension, Math review, Social skills)
20. Would you be interested in participating in parent workshops focused on child development, nutrition, or education? *
 SECTION 8: TEEN LEADERSHIP
21. Do you have a teen (ages 13–17) interested in volunteer/leadership opportunities within the program?
Clear selection
If yes, please provide the Teen's Full Name:
If yes, please provide the Teen's Age:
 SECTION 9: PERMISSIONS & AGREEMENT
22. I give permission for my child to participate in all planned program activities (educational, recreational, and field trips). *
Required
23. I give permission for my child to receive meals and snacks provided by the program. *
Required
24. I understand this is a structured program with clear behavior expectations, and I agree to support the program's staff in maintaining a safe and respectful environment. *
Required
25. Photo/Media Release: I give permission for my child's image/likeness to be used in promotional materials for Stored Goodness. *
SECTION 10: SIGNATURE
26. Parent/Guardian Name (Typed Signature) *
27. Date *
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