Meal Program Enrollment Selection

Parent/Guardian Name:*

Child's Name:*

Head Start / CSPP / Early Head Start / Home Base location:

Program Selection*

Yes, I want to participate in meal distribution. (Sí, quiero participar en la distribución de comidas.)
No, I do not want to participate in the meal distribution. (No, no quiero participar en la distribución de comidas.)

I give my permission for Fresno EOC Head Start 0 to 5 to deliver meals to my home during the COVID-19 pandemic.*

(Doy mi permiso para que Fresno EOC entregue comidas a mi hogar durante la pandemia Covid-19.)

Home Address:*

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Meal Program Selection Form