Food Delivery Information
This meal program includes breakfast and lunch.
All children under 18, including those not in school, qualify.
This form only needs to be completed ONCE per household for the duration.
Which schools are attended?
For multiple students, please select each school attended.
Nokomis Regional High
Nokomis Middle School
The town this household is located.
Example: 291 Williams Rd. (Town, State and Zip Code are not required)
How many children under 18 in the household will require meals?
This meal program includes breakfast and lunch. All children under 18, including those not in school, qualify.
Names of all the children in this household.
PLEASE NOTE: You only have to fill out this for ONE TIME to receive meals for the entire duration of school closure.
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This form was created inside of Regional School Unit #19.