Nutrition Mission Enrollment

Complete this form to enroll your child(ren) in the Nutrition Mission weekend backpack program.

ONE STUDENT PER SUBMISSION

Parent/Guardian Information

Parent/Guardian Name

Street Address

City

State

Zip Code

Phone Number

Email Address

Student Name

Electronic Signature

I understand my child(ren) will receive weekend food through the Nutrtion Mission program.

I am responsible for reviewing all food items for allergies and dietary needs.

I understand I may withdraw my child(ren) from the program at any time by notifying the school or the Nutrition Mission.

Thank you! Your enrollment has been