Meals On Wheels 4 Kids Meal Application

If you would like to apply for your child/ren to receive home delivered meal service when school is closed (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 the meal site at John Hopkins Middle School, Fairmount Park Elementary, Foundation for a Healthy St. Pete or SPPF M.A.S.T.R. Kids at Friendship Missionary Baptist Church emergency feeding sites?

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

Does your child have any dietary restrictions/allergies? (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 4 Kids, a Tampa Bay Network to End Hunger program, in partnership with the Juvenile Welfare Board, Pinellas County Food and Nutrition, and Daystar Life Center, will be delivering meals for this child at the home listed above when school is not in session. These meals will be delivered by volunteer drivers who have been background checked. The drivers will knock on the door or ring the doorbell and hand the meals to whomever answers the door, but will not enter the home unless there is an emergency. 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.
Yes

First and Last Name:
Date: