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
Conestoga Valley Christian Community Services, (CVCCS) will be offering Weekend Blessings again this year, beginning September 16th. Weekend Blessings is a program designed to help meet the nutritional needs of the children in the Conestoga Valley School District. Each Friday children enrolled in the program will receive a pack filled with food for use on the weekends.
Your Privacy
Your privacy is important to us. This information will only be available to the CVCCS Weekend Blessings Coordinator and your school social worker or 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 within a certain income range, if you would like more information on either of those services, please contact CVCCS at 717-208-3711.
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, and SCHOOL.
I verify that the information I’ve provided is accurate and complete. I have read, agree, and give my electronic signature authorization for TEFAP and PROXY forms. I certify that my household size & income make me eligible for participation in the program.*
- I Agree
Email
This field is for validation purposes and should be left unchanged.

About Weekend Blessings

Your Privacy

Safety

Other Helpful Services Available