No Child Hungry Program
(for Students in Cincinnatus Central School)
"No Child Hungry" program through Rural Services is teaming up with the faculty and staff of Cincinnatus Central School to offer a supply of nutritious meals and snacks, free of charge, for children over their weekends.Bags will be distributed by the teacher on the last school day before the weekend. Any CCS student is able to receive these weekly bags of food.
If you believe your child would benefit from this program, we encourage you to sign him/her up by printing this page and filling out the form below and returning it to the front office at CCS. Only one form is needed per family, BUT include information for each child participating. This information will be kept confidential between "No Child Hungry" and CCS. Once your child is signed up, he/she will receive food bags until he/she leaves CCS or until you no longer wish to participate.
We encourage you to take advantage of this program for your children.
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No Child Hungry Consent Form
(Please print clearly.)
Please sign my child(ren) up for "No Child Hungry." I understand my child(ren) will soon start receiving a bag of food at the end of each week for use over the weekend.
Today's Date: _______________________________________________________________
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Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) __________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) __________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
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Optional: Please check any box below, according to your interest(s) Understand that by doing so, you waive confidentiality, and the school will share your contact information with "No Child Hungry."
_____ I may be interested in helping pack food bags.
_____ I may be interested in serving as a volunteer with "No Child Hungry" at Rural Services.
Parent/Guardian name; _______________________________________________________________________________
Telephone number(s) : ________________________________________________________________________________
Parent/Guardian email address (if any) ___________________________________________________________________
Today's Date: _______________________________________________________________
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Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) __________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) __________________________________________
Child's name/Teacher?Grade __________________________________________________________________
Special dietary needs (e.g. diabetic, food allergy, kosher) ___________________________________________
------------
Optional: Please check any box below, according to your interest(s) Understand that by doing so, you waive confidentiality, and the school will share your contact information with "No Child Hungry."
_____ I may be interested in helping pack food bags.
_____ I may be interested in serving as a volunteer with "No Child Hungry" at Rural Services.
Parent/Guardian name; _______________________________________________________________________________
Telephone number(s) : ________________________________________________________________________________
Parent/Guardian email address (if any) ___________________________________________________________________
