Parent Information

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* 1. What is your name?

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* 2. Do you have internet access at home?

Yes

No

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* 3. Do you have a device such as a laptop, Chromebook, iPad/Tablet, or smartphone that can connect to the internet?

Yes

No

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* 4. If you answered yes to the previous question, please list what devices you have at home.

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* 5. Will your family members ages 1-18 be participating in the breakfast/lunch program?

Yes

No

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* 6. If you answered yes to the previous question, please provide names, ages, and grade levels of your children that will be participating in the breakfast/lunch program.

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* 7. Please provide the following information.

Name

Email Address

Phone Number