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Weekend Blessings Sign-Up
Please click this link FIRST to review the required Declaration of Need form and Proxy form before proceeding.
*Your electronic signature for the Declaration of Need form and Proxy forms are required at the end of the below 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
Alabama
Alaska
American Samoa
Arizona
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Delaware
District of Columbia
Florida
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Guam
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North Carolina
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Northern Mariana Islands
Ohio
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Puerto Rico
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South Carolina
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Tennessee
Texas
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U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Email
This field is for validation purposes and should be left unchanged.
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