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Note: Please make sure all required information is completed or your form submission will not be forwarded.
*
1.
Contact Person's Information
(Required.)
Name*
E-mail*
Phone*
Cell Phone*
Name
E-mail
Phone
Cell Phone
*
2.
Site Information
(Required.)
Site Name*
Site Address*
City*
State*
County*
Site Phone*
Site Fax
*
3.
Type of Site
(select one)
*
(Required.)
Recreational
School
Camp (Overnight)
Church
Day Care
Migrant
Homeless
College
Other
*
4.
What type of meals do you plan to serve?
(No more than two, unless the site is an overnight camp or migrant site, in which three meals are allowed.) Note: Local sponsors may not offer all meal types. Sites cannot offer both Lunch and Supper.
(Required.)
Breakfast
AM Snack
Lunch
PM Snack
Supper
*
5.
Does your organization have proof of 501c3 federal tax exempt
(non-profit)
status?*
(Required.)
Yes
No
6.
Does site have kitchen facilities (not always required)?
Yes
No
7.
Will there be organized activities at the site (not always required)?
Yes
No
*
8.
Estimated number of Children the site would serve
(Please make as realistic an estimate as possible.)
(Required.)
Minimum*
Maximum*
9.
For the estimated number of children does the site have:
Yes
No
Don't Know
Shelter for inclement weather?
Yes
No
Don't Know
Adequate storage for prepared or delivered food?
Yes
No
Don't Know
Storage space for records at the site?
Yes
No
Don't Know
Adequate refrigeration?
Yes
No
Don't Know
Access to a telephone?
Yes
No
Don't Know