Breakfast/Lunch Request Form
Are you interested in receiving a free lunch/breakfast? ( all children age 1 year to 18 years old qualify for a free meal) *
Names of children you want meals for: *
Your answer
Meal Delivery: Will you be doing curb-side pickup in front of the Grade School, or require rural delivery within the school district boundaries? Child must be present to receive meal, however, child may receive meal without adult present. *
If requesting delivery, what is your delivery address:
Your answer
Please check which days you are requesting meal(s). *
Required
Submit
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