If the children attend a school district other than Philadelphia School District, please enter the name of the school district and the number of children per school district below:
Please only fill out two (2) rows above. The two meals you wish to have us provide meals.
By signing your name in the below field you acknowledge that:
In accordance with Federal and US Department of Agriculture policy, this institution is prohibite from discriminating in the basis of race, color, national origin, sex, age, or disability.