Summer Food Service Request
Please fill out this form to request deliveries of breakfast and lunch to your home over the summer. This program is offered to children enrolled in the North Shore School District. Please contact the Food Service Office at or Director of Counseling, Dan Doherty, at with any questions. Deliveries will begin on July 6th.
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Parent/Guardian Name: Last, First *
Student 1 Name: Last, First *
Student 2 Name: Last, First
Student 3 Name: Last, First
Student 4 Name: Last, First
Student 5 Name: Last, First
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
Address for meal delivery *
School(s) in Sept 2021 *
Number of children receiving meals *
Any special delivery instructions (ie: second floor of house or leave at side door..etc.)
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