FOOD BANK BACKPACK REQUEST/INFORMATION FORM

Dear Parent/Guardian:

            Raymond Central will be starting a backpack program in conjunction with the Food Bank for the 2011-2012 school year. Backpacks are sent home each Friday and are filled with food to feed a family during the weekend.

The food used for the Food Bank Backpack Program consists of purchased food to ensure a consistent supply of food for each backpack. Various menus include peanut butter and jelly, concentrated fruit juice, boxes of cereal, macaroni and cheese, canned fruits and vegetables along with bread and egg vouchers. Vouchers for milk may also be issued.

Sending in this form will not change whether your children receive free or reduced price meals.  Sending in this form does not guarantee your family’s participation in the program.

If you are not interested in participating but would like to sponsor a family you can do so by sending a check to the Raymond Central Education Foundation with “backpack” written on the memo line. ANY donation amount is appreciated and the donation is tax deductible.

_____  YES! My family would like to participate and receive a backpack on each last school day of the week and return the backpack on the first day of the next school week. A notification letter will be sent if your family will be receiving a backpack of food.

Please list number of children__________ and number of adults________ that will be receiving food for the weekend.

Please list the name and grade of the child who is to bring the backpack home.

Name___________________________________      Grade_________________

Signature of Parent/Guardian_______________________________________________

Printed Name: _____________________________________________________

Address: __________________________________________________________

City/State/Zip: _____________________________________________________

For more information, you may call Mrs. Shelly Dostal at Valparaiso Elementary-784-3301.

Please return this form in an envelope to your respective school attendance center by August 27, 2011. Information submitted is to be kept confidential.