Summer 2026 Meal Pick-Up Order Form

Name of primary person who will pick up food (must be a parent or legal guardian of every children listed in this form)

First NameLast Name

Name of alternate person who may pick up food:

First NameLast Name

Email (for order confirmation and reminders):

Phone:

Please enter a valid phone number.Format: (000) 000-0000.

Number of children 18 and under in the household:

1st Child: First and Last Name

2nd Child: First and Last Name

3rd Child: First and Last Name

4th Child: First and Last Name

5th Child: First and Last Name

6th Child: First and Last Name

7th Child: First and Last Name

# Weekly Meal Packs

Check each date for May/June, July, and August that you will be picking up food.

MAY/JUNE

JULY

AUGUST

Does your child have any special meal requirements? (ie. food allergy, ...).

Please list the meal requirements. If the district is unable to meet the accommodations, the parent will be notified by email.

Signing and submitting this form attests that you are the parent or legal guardian for the children listed, and you certify the following statements are true.

I attest that I am the parent or legal guardian for each child listed on this form.
I understand it is my responsibility to ensure the proper storage and preparation of meals once received.
I understand the child(ren) listed is only eligible to receive one meal per meal service type (i.e. Breakfast, Lunch, Supper, Snack).
I agree to follow all food safety instructions included with the meals.
My child(ren) are not formally enrolled in child care with the individual(s) authorized to pick up meals.
I certify that each child listed is ineligible to receive meals provided through another Child Nutrition Program such as the Child and Adult Care Food Program, Summer Food Service Program, or Seamless Summer Option if I choose to enroll in grab and go meals.
I certify that I understand that children who receive meals from Denver Elementary or Wilmington Middle School during the summer can not receive meals through the this pick-up program (Rural Non-Congregate Program).
I understand that I may be asked to provide identification at meal pick-up.
USDA is an equal opportunity provider, employer, and lender. View the USDA Non-Discrimination Statement.

I attest that I am the parent or legal guardian for each child listed on this form.