100% Virtual Meal Registration Form

100% Virtual Breakfast & Lunch Meal Registration Form

Please complete the survey if your child is participating in the 100% virtual model (at home instruction) and you are interested in your child(ren) receiving a free breakfast and lunch. Meals will be available for pick up on Tuesday and Friday at both the Carter St. District Office door or at the former school in Little Valley on Thompson Avenue.
Both breakfast and lunch meals can be picked up as follows:

Tuesday (breakfast and lunch meals for Wednesday, Thursday & Friday) from 9:30 a.m. - 10:00 a.m. or 5:00 p.m. - 5:30 p.m.

Friday (breakfast and lunch meals for Monday & Tuesday) from 9:30 a.m. - 10:00 a.m. or 5:00 p.m. - 5:30 p.m.

1. Parent/Guardian Information:

First Name

Last Name

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Phone Number

2. Please complete student information

Space Cell	Student First Name	Student Last Name	Student Grade Level
Student # 1	Student # 1: Student First Name	Student # 1: Student Last Name	Student # 1: Student Grade Level
Student # 2	Student # 2: Student First Name	Student # 2: Student Last Name	Student # 2: Student Grade Level
Student # 3	Student # 3: Student First Name	Student # 3: Student Last Name	Student # 3: Student Grade Level
Student #4	Student #4: Student First Name	Student #4: Student Last Name	Student #4: Student Grade Level
Student # 5	Student # 5: Student First Name	Student # 5: Student Last Name	Student # 5: Student Grade Level
Student # 6	Student # 6: Student First Name	Student # 6: Student Last Name	Student # 6: Student Grade Level
Student # 7	Student # 7: Student First Name	Student # 7: Student Last Name	Student # 7: Student Grade Level

3. Please select am or pm pick up time.

4. Please select location