Summer Meal Registration Form
Register to participate in the summer meal program.
How many children in the household?
*
*
Rows
Participant Full Name
Participant Age
Dietary Restrictions? Y/N
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
What are the dietary restrictions?
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pick up or Delivery
*
Pick up
Delivery (only available if within city limits)
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Proof of Income
*
Browse Files
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of
Photo ID of Parent/Guardian
*
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of
Child(ren) Birth Certificate
*
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of
Photo Consent
I, the undersigned, hereby give my consent to Born to Care to photograph and/or video record me and/or my child(ren) during events and activities organized by the organization. I understand that these images may be used for promotional purposes, including but not limited to printed materials, social media, and the organization's website. I understand that my participation is voluntary and that I may withdraw my consent at anytime by contacting Born to Care.
Photo Consent
*
Child(ren) Name(s)
*
Date
*
-
Month
-
Day
Year
Date
Signature
*
Additional Notes
Register
Should be Empty: