Meal Delivery Application

Your Name *

Your Address *

Phone Number *

What type of meals you want to be delivered? (Please select one) *

What type of meals you want to be delivered? (Please select one) *

How many children between the ages of 1-18 do you need meals for? *

Please indicate the programs you are interested in participating in by checking all boxes that apply. *

• Career Technical (CDA, First Aid and etc.)
• After School Tutoring
• Education Classes
• Citizenship Training Classes
• ESL Classes
• Health & Wellness Classes
• Youth Crime Prevention Classes
• Sports (Basketball, Soccer, Swimming)
• Youth Talent Show
• SERC Nutrition Program