BackPack Food Program Registration Form
Your child(ren) are eligible for this program if they are in grades K-5 and you are not financially able to provide enough food for them. If you are able to provide enough food for your child(ren) without assistance, please refrain from signing up.

Terms of enrollment: I enroll the child(ren) listed below for the 2017-2018 school year. The BackPack Food Program has my permission to contact the school to confirm food allergies. I understand that enrollment in the BackPack Food Program may be discontinued if my child(ren) refuse to bring the food packs home or if they eat the food on the school bus.

Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Phone Number *
Your answer
Do you give permission for your child(ren) to fill out anonymous surveys about the BackPack Food program? *
Pick which school student(s) attend *
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