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Breakfast Learning Program - 26/27 School Year

WEST BENCH BREAKFAST LEARNING PROGRAM

INFORMATION & CONSENT FORM

DEAR PARENTS AND GUARDIANS:

We are pleased to announce that the Breakfast Club will once again be offered at West Bench Elementary. Breakfast will be served Monday to Friday from 8:30 am until 8:45 am in the kitchen (early bus students will be welcomed at 8:00 am). Students are invited to enjoy breakfast at no cost to their families. When arriving for Breakfast Club, students should enter through door D or the front door of the school, wash their hands, and then line up at the kitchen door to order their breakfast.

Student Name*

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Parent/Guardian Name*

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If your child has any food allergies, please list below:

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Please select one

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I GIVE MY CONSENT for my child to participate in the Breakfast Meal Program.

I DO NOT CONSENT for my child to participate in the Breakfast Meal Program.