Weekend Blessings Form

Before submitting this form, please click on the TEFAP (income guidelines) and PROXY form links below, review each carefully, and provide your electronic signature at the end of this form.

TEFAP Form

PROXY Form

About Weekend Blessings
Weekend Blessings is a program offered by CVCCS to K-12 students in the Conestoga Valley School District. Each Friday, students enrolled in the program will receive a “bundle” of easy to prepare meals from their school guidance counselor to take home for the weekends consisting of two breakfasts, two lunches, two dinners, and snacks.
Your Privacy
Your privacy is important to us. This information will only be available to CVCCS and your school social worker or guidance counselor.
Safety
Parents/Guardians are responsible to check Weekend Blessings packs each week to ensure that the foods are appropriate and safe for your child. Foods may contain nuts, peanut butter, or other allergens.
Other Helpful Services Available
CVCCS also has a food bank and clothing bank that are available free of cost to those who qualify. Please contact CVCCS at 717-208-3711.
Please fill out the below in its entirety:
Parent/Guardian Name*
First Last
Parent/Guardian Phone*
Parent/Guardian Email*
Street Address*
Street Address City State ZIP Code
Student Information: List each student's FIRST & LAST name, DATE OF BIRTH, SCHOOL and GRADE (K-12).*
For example: John Doe, 1/1/2014, Smoketown Elementary, 5th grade.
ELECTRONIC SIGNATURE*
I verify that the information I’ve provided is accurate and complete. I have read, agree, and give my electronic signature authorization for the TEFAP and PROXY forms. I certify that my household size & income make me eligible for participation in the program.
- I Agree
Name
This field is for validation purposes and should be left unchanged.

About Weekend Blessings

Your Privacy

Safety

Other Helpful Services Available

Please fill out the below in its entirety: