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!
* Required
Parent/Guardian First and Last Name
*
Your answer
Address:
Your answer
Phone Number:
*
Your answer
Email Address:
Your answer
What county do you live in?
Franklin County
Cumberland County
Clear selection
Child 1: Full Name, Grade, School, and any Food Allergies
*
Your answer
Option 1
Clear selection
Child 2: Full Name, Grade, School, and any Food Allergies
Your answer
Child 3: Full Name, Grade, School, and any Food Allergies
Your answer
Child 4: Full Name, Grade, School, and any Food Allergies
Your answer
Child 5: Full Name, Grade, School, and any Food Allergies
Your answer
Full Name(s), Grade(s), School(s), and Food Allergies for remaining Child(ren):
Your answer
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).
*
Yes, on Thursday mornings
Yes, on Thursday afternoons
Yes, on Friday mornings
Yes, on Friday afternoons
No one is home on Thursdays
No one is home on Friday
Other:
Required
What kitchen appliances and tools do you have access to?
*
Oven
Stove
Micowave
Can opener
Refrigerator
Freezer
Running Water
Sharp Knives
Whisk
Pots
Pans
Required
Is there anything else that we need to know?
Your answer
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:
Your answer
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:
Your answer
How did you hear about Hound Packs?
*
Shippensburg Community Resource Coalition Website
Facebook
Instagram
School Teacher
School Counselor
2-1-1
Human Service Provider (Case manager, Christ Among Neighors, SPO, Tri-County Community Action, etc.
Other:
Required
Are you a provider completing this form?
Yes
No
Clear selection
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