Bluestem In-District Rural Food Sign-Up
We ask that any in-district rural students wanting a breakfast and lunch Grab/Go sack to use our rural sign-up sheet. You must complete the form with complete addresses and phone numbers and students must be present at the time of delivery. These meals will be available to children ages 1-18 years of age. Students will be provided multiple meals (breakfast & lunch) to last multiple days throughout the week. Delivery is extended to this sign-up sheet for the Bluestem in-district rural students.

*If you will not be around during any of the designated drop days please let us know at least one day prior by emailing
Number Of Children Between the Ages of 1-18: *
Parent/Gaurdian's Name: *
Phone Numer: *
Street Address: *
City *
Consent for Disclosure:
By submitting this form you are agreeing to allow your information to be shared within the Child Nutrition Program benefits. This information will only be shared with the personnel associated with the program.

*This institution is an equal opportunity provider.
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