Summer 2021 Gilford Got Lunch Application Form

Gilford Got Lunch Application form (2021 Summer Program)

* Indicates required field

Parent's Name(s) *

First

Last

Will someone be home to accept delivery? *

Yes No

Delivery Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Phone Number *

Email *

Special considerations we may need to know about delivering food to your address between 9 and 12 on a Monday morning? ie: Animals, specific place to leave bag, etc. *

#1 Child's Name *

#1 Child's DOB (mm/dd/yyyy) *

#1 Child's School *

#2 Child's Name *

#2 Child's DOB (mm/dd/yyyy) *

#2 Child's School *

#3 Child's Name *

#4 Child's Name *

#3 Child's DOB (mm/dd/yyyy) *

#4 Child's DOB (mm/dd/yyyy) *

#3 Child's School *

#4 Child's School *

ALLERGY and/or SPECIAL DIETARY NEEDS:
Please understand we are NOT able to accommodate allergies and/or special dietary need requests.

By checking the box below you waive all liability from your family’s participation in this program and all of the program’s sponsoring and collaborating partners. *

I agree to the terms listed above

Your Name *

First

Last

Submit