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Acorn Breakfast To Go Program

 

The Acorn Community’s Breakfast To Go Program will begin on Monday, October 2, 2023.  It will take place every Monday to Friday (excluding holidays). The program is available to all school age students at no cost. Proof of school attendance may be requested.

If your child will be attending the program, the following permission form must be signed. SHIP/PYV will attempt to ensure a nut-free environment but please indicate any food allergy your child may have below.

Breakfast Brown Bag
Parent or Guardian Name
Parent or Guardian Name
First Name
Last Name
Name of Child 1
Name of Child 1
First
Last
Name of Child 2
Name of Child 2
First
Last
Name of Child 3
Name of Child 3
First
Last
Name of Child 4
Name of Child 4
First
Last
Name of Child 5
Name of Child 5
First
Last
Name of Child 6
Name of Child 6
First
Last
Name of Child 7
Name of Child 7
First
Last
Name of Child 8
Name of Child 8
First
Last
Do any of the above children have any food allergies?
Consent
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