Parent Consent

PARENT CONSENT FORM
Revised (3/2025)

Schools/non-profit organizations providing non-congregate meals under the Summer Break Café (SFSP) and SSO have the option to provide meals through home delivery or parent pick up. Sponsors must obtain written consent from a child’s parent or guardian to pick up meals on the child’s behalf or receive home delivered meals. Schools/non-profit organizations must maintain accountability, program integrity, and household confidentiality.

A guardian is defined as an adult who has a direct caregiver relationship with a child and is authorized to pick up meals for that child, as part of the “SUN Meals To-Go” for non-congregate service option.

PLEASE NOTE: Childcare providers who care for whole groups of unrelated children do not fall under the category of a “guardian” and cannot collect program meals on behalf of parents or guardians for children attending their childcare.

Name*

First NameLast Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Meal Distribution Type Selection:*

Home DeliveryParent Pick Up

List all children in the household that will receive a meal along with their current age:*

Parent/ Guardian Signature & Date*

This is a fill in the blanks field. Please add appropriate blank fields and text.

Form

Parent Consent Form