Hound Packs Enrollment
Please complete the following form to enroll your family in the Hound Packs program during this time. If one of your children is enrolled in K-12, a school counselor or the social worker will reach out to you. Thank you!
Parent/Guardian First and Last Name *
Address:
Phone Number: *
Email Address:
What county do you live in?
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Child 1: Full Name, Grade, School, and any Food Allergies *
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Child 2: Full Name, Grade, School, and any Food Allergies
Child 3: Full Name, Grade, School, and any Food Allergies
Child 4: Full Name, Grade, School, and any Food Allergies
Child 5: Full Name, Grade, School, and any Food Allergies
Full Name(s), Grade(s), School(s), and Food Allergies for remaining Child(ren):
At this time, the food bags will be delivered by a Hound Packs volunteer. Is someone home on Thursday or Friday to receive the food bags? (Check all that apply). *
Required
What kitchen appliances and tools do you have access to? *
Required
Is there anything else that we need to know?
By typing my full name below, I consent to enroll my child(ren) in the Hound Packs food program for the current school year and the years following as long as my child(ren) remain in the SASD or I choose to discontinue the program. I understand that enrollment of my child(ren) in this program is voluntary, and I can discontinue the program at any time by contacting their school counselor or Head Start staff. *
Please type your full name below:
By typing my name below, I give Shippensburg Area School District and Head Start my permission to share the above student(s) information with Shippensburg Community Resource Coalition (SCRC) for the purpose of participation in the Hound Packs food program. Information shared will be limited to what is on this form. *
Please type your full name below:
How did you hear about Hound Packs? *
Required
Are you a provider completing this form?
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