Meal Request RURAL and Door to Door SPED students only

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If this form is filled out after 7:00AM, meals will not start until tomorrow.

I live on a rural route in USD 413 district or am picked up at my house by transportation. *

Rural

SPED

Address where delivery will occur *

Number of children ages 1-18 in your home who are eligible for meals. *

Name of Each eligible child (make sure you have a name listed for each eligible child)

I understand that meal delivery will occur between 11:00am-12:30pm. Meals can only be provided to children who are 18 and under. If my child has a food allergy, I understand that I am fully responsible and will take every precaution to ensure these children will not consume foods that will cause them to become ill. *

Yes

I understand someone must be home at the time of delivery to accept the meals. No meals will be left unattended. *

Yes

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