Back Pack Program Sign Up Form

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The Back Pack Program provides a bag weekly full of kid-friendly, shelf-stable food and snacks for your child to take home and eat over the weekend. They will receive foods like cereal, pudding, fruit cups, granola bars, microwavable meals and other items. The program is free and confidential.

If you would like to enroll multiple children, please submit one form per child. If you have any questions about the program, please contact Maureen Bjerke or Amber Lockhart.

BY SUBMITTING THIS FORM, YOU GIVE YOUR APPROVAL TO ENROLL YOUR CHILD IN THE BACK PACK PROGRAM.

Student's Name *

Student's Teacher *

Grade

Please list any known food allergies. *

By clicking the box below, you agree to enroll your child in the Back Pack Program. *

Yes, I want my child to participate in the program.

Required

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