Summer Food Program Registration 2021

Please note you will need to do a separate registration for each child.

Ross County Community Action’s Summer Food Program will provide lunches to children ages 1-18 at a variety of locations within Ross County. Children will be provided a week’s worth of lunches on one designated day per week. Our Summer Food Program will be focus following schools: Huntington, Paint Valley, Southeastern, Zane Trace, and Unioto. Please select your desired location/day for lunch pick-up below. The Chillicothe City Schools will be providing lunches to children living in the Chillicothe School District. For more information about their program, please contact the Chillicothe City Schools.

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* 1. Child First Name

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* 2. Child Last Name

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* 3. Child's age

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* 4. Childs Racial/Ethnic Information (optional)

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 5. Family Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Contact Email Address

Contact Phone Number

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* 6. Does your child have any food allergies?

Yes

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* 7. If yes, please check all that apply. Doctor/physician note will be required.

Peanuts/Nuts

Milk/Dairy

Gluten/Wheat

Other (please specify)

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* 8. Please select preferred location for lunch pick-up. Please note that 5 lunches will be provided one time per week at the designated location, date, and time.

Zane Trace School - 946 St. Rt. 180 Chillicothe, OH 45601 - Mondays

Unioto School - 14193 Pleasant Valley Rd. Chillicothe, OH 45601 - Tuesdays

Southeastern School - 2003 Lancaster Rd. Chillicothe, OH 45601 - Wednesdays

Huntington School - 188 Huntsman Rd. Chillicothe, OH 45601 - Thursdays

Paint Valley School - 7475 US-50 Bainbridge, OH 45612 - Thursdays

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* 9. Will transportation to one of these locations be an issue for your family?

Yes

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* 10. If Yes, a Ross County Community Action staff member will contact you. What is the best way for us to reach you?

E-mail

Phone

Thank you for registering for the Summer Food Program. For more questions, please contact Josh Garrett at jgarett@rossccac.com or 740-702-7222 ext. 122