Students Name:

___________________________________

Homeroom:
______________________________________

Allergies or Dietary restrictions?

_______________________

Number of children in the home?

_______________________

Dear Parent/Guardian,
The Blessings in a Backpack program is now available here at Claymont Intermediate. The program is designed to
provide food every Friday to children that would benefit from supplemental nourishment over the weekend.
Bags will be dispensed in a discreet manner by myself or another caring staff member. This program runs throughout the
school year and we are hoping to grow the program steadily. There is no cost associated to this program. If you wish for
your child to participate in the program please sign below and return the letter to the school. Thank you!

Yes, I want my child to participate in the Blessings in a Backpack program.

Signature: ________________________________

Students Name:
___________________________________

Homeroom:
______________________________________

Allergies or Dietary restrictions?

_______________________

Number of children in the

home? _______________________

Dear Parent/Guardian,
The Blessings in a Backpack program is now available here at Claymont Intermediate. The program is designed to
provide food every Friday to children that would benefit from supplemental nourishment over the weekend.
Bags will be dispensed in a discreet manner by myself or another caring staff member. This program runs throughout the
school year and we are hoping to grow the program steadily. There is no cost associated to this program. If you wish for
your child to participate in the program please sign below and return the letter to the school. Thank you!

Yes, I want my child to participate in the Blessings in a Backpack program.

Signature: ________________________________