Pre-Registration for Healthy Kids Iowa
Please complete a separate pre-registration form for each child ages 4-18 in your household.
Please select the date and time (either morning or afternoon) you will be at CVFP.
*
Note about reservation times:
If you register for the 9:00am time slot, you are welcome to come anytime between 9:00am-11:45am. If you register for the 12:00pm time slot, you are welcome to come anytime between 12:00pm-2:45pm.
Your name (parent/guardian)
*
First Name
Last Name
Your Date of Birth (parent/guardian)
-
Month
-
Day
Year
Date
Child's Age
*
Reminder: The Healthy Kids Iowa Program is for children aged 4-18.
Child's Name
*
First Name
Last Name
If you would like to receive a reminder email, please provide your email address:
example@example.com
If you would like a confirmation text, please provide your phone number:
Please enter a valid phone number.
Note:
If you have not been to Cedar Valley Food Pantry since July 1st there will be additional paperwork for you to complete upon arrival.
Submit
Should be Empty: