Meals On Wheels for Kids Application

If you would like to apply for your child/ren to receive home delivered meal service while children are not at school (ie. emergency closing, holiday break, etc.), please fill out the form below. After we receive the application, we will call you to discuss eligibility. 

If you have more than one child that is 18 years of age or younger, and can eat solid foods, that you would like to receive home delivered meals, please submit additional applications. Thank you!

    MOW4Kids Recipient Information

    Can your child access an emergency meal site to receive grab and go meals in your area?

    Does your child participate in the free/reduced lunch program?

    Does your child have any dietary restrictions/allergies? Please note that we cannot deliver specialized meals. If your child has a food allergy or dietary restriction, please self monitor. (required)
    YesNo

    How did you hear about Meals On Wheels Saint Petersburg?
    SchoolPantryFlyerSelfSomeone who receives mealsOtherSocial MediaTV/News/PrintFamily/FriendInternetSocial Worker/Case ManagerVolunteer


    Race
    Asian or Pacific IslanderNative American or American IndianBlack or African AmericanOtherHispanic or LatinoWhite


    Gender
    FemaleMaleOther


    Primary language?
    EnglishSpanishOther


    What are the child's living arrangements?
    ParentLegal GuardianWith familyWith grandparent/s



    Do you participate in SNAP or WIC programs? (required)
    NoYes, SNAPYes, WICYes, Both



    Will an adult 18 yrs or older be home during meal delivery? (required)
    NoYes


    Do you have pets?
    CatDogNo


    Emergency Contact Information (please provide information for someone other than the person filling out this form)




    Information for Head of Household / Person Requesting Meals On Wheels 4 Kids



    What is your current marital status?
    SingleMarriedDivorceWidow

    +If you have more than one child in your household, under the age of 18 that can eat solid foods, please submit an additional form for each child that you would like to sign up to receive MOW4Kids.

    I acknowledge that Meals On Wheels for Kids, a Tampa Bay Network to End Hunger (TBNEH) program, will be delivering meals for this child at the home listed above when school is not in session or when child/ren are attending school remotely from home. These meals will be delivered by volunteer drivers who have been background checked. I give permission for the Meals On Wheels 4 Kids drivers to deliver meals to the child listed above, even if no responsible adult is present.
    YesNo

    I will enforce social distancing and I understand that volunteer drivers delivering the food will enforce social distancing. I will allow volunteers to place the meals at my front door, then knock on the door or ring the doorbell and step away, while someone from my house retrieves the meals. I will practice social distancing by not touching the volunteers, taking food from each other or coming within 6 ft of them.
    YesNo

    I understand that if I live in Pinellas County and in an apartment complex, volunteers will call me when they are 15 minutes away and someone is to meet the school bus at the front of the apartment complex. I will stand back and practice social distancing while awaiting direction from volunteers to retrieve the food delivery.
    YesNo

    I understand that someone must be home to receive the food between 10am-2pm on the delivery day. I will notify TBNEH/Meals On Wheels for Kids by calling 813-344-5837 if no one will be home to receive the food. I will notify TBNEH/Meals On Wheels for Kids at least 2 business days (M-F) before my scheduled delivery. If I don't call in advance, I will receive a strike on my account. If I receive three strikes from someone not being home to receive the food, my family will no longer be able to participate in this program.
    YesNo

    First and Last Name:
    Date: