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Meal Delivery Application
Your Name
*
Your Address
*
Email Address
*
Confirm Email Address
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Phone Number
*
What type of meals you want to be delivered? (Please select one)
*
Breakfast and Lunch
Breakfast and Supper
What type of meals you want to be delivered? (Please select one)
*
Cold Food
Hot Food
Shelf Stable Food
How many children between the ages of 1-18 do you need meals for?
*
Please indicate the programs you are interested in participating in by checking all boxes that apply.
*
Career Technical (CDA, First Aid and etc.)
After School Tutoring
Education Classes
Citizenship Training Classes
ESL Classes
Health & Wellness Classes
Youth Crime Prevention Classes
Sports (Basketball, Soccer, Swimming)
Youth Talent Show
SERC Nutrition Program
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