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* 1. Please fill out the following information for the students you want to receive food

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* 2. STUDENT NAME

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* 3. STUDENT NAME

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* 4. STUDENT NAME

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* 5. STUDENT NAME

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* 6. STUDENT NAME

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* 7. STUDENT NAME

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* 8. STUDENT NAME

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* 9. STUDENT NAME

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* 10. STUDENT NAME

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* 11. Please provide the address that the food needs to be delivered to:

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* 12. What is your preferred form of communication to receive notification of the time the food will be delivered

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* 13. Please provide your email addess

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* 14. If you are aware of other families in need that do not ave access to this survey please help them contact the school office at 503 392 3194 Ext 403 and we will work to support them.

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* 15. FOOD DELIVERY WILL BEGIN ON TUESDAY MARCH 17

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