Meals On Wheels for Kids Application – Tampa Bay Network To End Hunger

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

Child First Name (required)

Child Last Name (required)

Child Date of Birth (Month/Day/Year)

Child Home Address (required)

Name of Apartment Complex / Gate Code

City (required)

Zip (required)

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

Child Home Phone (required)

Child Cell Phone, if available

What school does your child attend?

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

If so, please explain in as much detail as possible.

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

How many people live in the child's household?(required)

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

What is the net household income, after taxes?(required)

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)

Emergency First Name

Emergency Last Name

Emergency Contact Phone

Emergency Contact Relationship

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

Your First Name (leave blank if same as emergency contact information)

Your Middle Name

Your Last Name (leave blank is same as emergency contact information)

Please list any other legal names you have gone by.

Relationship to person needing meal service? (leave blank is same as emergency contact information)

Phone Number, where you can most easily be reached at

Phone Number 2

Your Email

Your Birthday (Month/Day/Year)

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: