Parent Waiver for pick up Summer 2021
Parent/Guardians Please use this form to order your school breakfasts & Lunches for your students 1-18 that are in your household during Summer Meals. These meals will be free for June and July 2021 with the support of USDA funding.

If you have questions please call Terri Markham 620-432-2506 or email markhamt@usd413.org



1)Complete your information
2) Complete students/children info
3) Choose your pick up site
Email *
Parents/Guardians Phone number *
Parents/Guardians last name *
Parents/Guardians First name *
This Waiver is for parents to pick up meals for their children ages 1-18 who will not be present at meal pickup. You only need to do the waiver one time!!
Clear selection
Choose ONE Pick Up Location. You need to pick up at the location you selected. You must pick up at the time slots for the location you picked.( NO LATE PICK UPS WILL BE ALLOWED)
Locations *
Please complete this section based on the number of meals you would like to order. Remember: You can only order for children 1-18 in your household.
#1 Students LAST Name *
#1 Students FIRST Name *
#1 Students Grade Level *
Do you have a second child who will need meals? *
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