ITHACA FREE SUMMER FOOD PROGRAM

ITHACA FREE SUMMER FOOD PROGRAM

MUST SIGN UP BY JUNE 12, 2025
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
You will be participating in our free summer food program*

YESNO
For how many students do you need meals?*

012345678910
Please enter the student(s) names
Please pickup your food at the Elementary Door on Wednesday's from 9:30 AM to 5:30 PM, beginning June 25 and ending August 20.
A CAMERA DOORBELL will be installed near the ELEMENTARY DOOR. Please follow istructions located near the doorbell to summon a food service worker.

* Once you have activated the doorbell, please stay OUTSIDE your vehicle as a food service worker will bring the food to you.

* YOU are responsible for packing your own vehicle.
Will you pick-up meals the week of June 23?*

NO
June 25 pick-up time (between 9:30a and 5:30p)

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of June 30?*

NO
July 02 pick-up time (between 9:30a and 5:30p)

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of July 7?*

NO
July 09 pick-up time (between 9:30a and 5:30p)

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of July 14?*

NO
July 16 pick-up time (between 9:30a and 5:30p)

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of July 21?*

NO
July 23 pick-up time (between 9:30a and 5:30p)

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of July 28?*

YESNO
July 30 pick-up time (between 9:30a and 5:30p)*

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of August 4?*

YESNO
August 06 pick-up time (between 9:30a and 5:30p)*

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of August 11?*

YESNO
August 13 pick-up time (between 9:30a and 5:30p)*

Hour / Minutes

AM/PM Option
Will you pick-up meals the week of August 18?*

YESNO
August 20 pick-up time (between 9:30a and 5:30p)*

Hour / Minutes

AM/PM Option
If there is an emergency and you are unable to make it to your scheduled pickup time, please call the School Office at 608-585-2311 on MONDAY of the week you are unable to complete the pickup. We will have the office staffed from 9a to 3p for phone calls.
The district does not get reimbursed for food that is not picked up. If you fail to pickup your food at your scheduled time TWO times during the Summer Food Program, we will stop providing food for your child / children.*

I acknowledge the above statement
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