BTMS Weekend Food Bag Form

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If your family would benefit from receiving a bag of food weekly, please complete this short form so we can be sure to include you in our district’s “Backpack Program.” This program is confidential and will not be shared unless given permission by you. If you have any questions about this resource, please reach out to Mr. Smith, our liaison for the program at smithd@fortmillschools.org.

BTMS Student Name (s) *

Grade Level *

6th

7th

8th

Would you like your child to receive the food bag? *

Yes

Parent/Guardian Name & Email Address *

Parent/Guardian Phone Number *

Please list any dietary restrictions and/or food allergies that we should be aware of. *

Any additional information you would like to share

Submit

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