Snack Packs
Dear Parent(s):

The Samaritan Community Center is partnering with schools to provide bags of food to eligible children on a weekly basis through the SnackPacks for Kids program. The program will provide 8-10 food items to students each Friday afternoon so they will have food available for the weekend. These snack bags will be placed privately into each student’s backpack weekly.

The following is a list of foods that will usually be provided: Cereal Bars, Fruit Cups, Pudding Cups, Fruit Snacks, Cereal, Slim Jim, Cheese and Crackers, Easy Mac, Shortbread Cookies, and Soy Butter. Due to allergies, no peanut products will be packed in the SnackPacks.

If you would like for your child to participate in this program, please complete the information below. By completing the form, you are digitally signing that you agree to have your child participate in the SnackPack program.


Roger Sharp

School Coordinator

Parental Permission:

The undersigned parent or legal guardian agrees to allow my child or children to participate in the SnackPacks for Kids Program. I have read the list of food items shown above and have no objection to SnackPacks for Kids providing these or similar food items to my child to take home on the weekends.

Email address *
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent Email Address
Your answer
Is your child on Free or Reduced Lunches? *
How many children are in your home? *
Your answer
How many children are in the Middle School? *
Your answer
What is the name of the oldest child in the Middle School? *
Your answer
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