Directions: Complete by May 1, 2026. Call 334-614-6538 if needed.

Please Select Which Area You Currently Live In Below 👇 ( if your area is not listed we don't deliver there currently) *

Date *

Parent/Guardian Name *

Phone *

Email *

Address *

Street Address

City

State

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Meal Option (Delivery of Pick up) *

Child Information
Enter each child’s name, age, school, and allergies below.

Child Name 1 *

Child Age 1 *

Child School 1 *

Child Allergies 1

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Child Name 2

Child Age 2

Child School 2

Child Allergies 2

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Child Name 3

Child Age 3

Child School 3

Child Allergies 3

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Child Name 4

Child Age 4

Child School 4

Child Allergies 4

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Child Name 5

Child Age 5

Child School 5

Child Allergies 5

Authorized Pick-Up Contacts
Only these individuals may receive meals with ID.

Authorized Contact Name *

Authorized Contact Phone Number *

Signature *

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Signature Date *

Directions: Complete by May 1, 2026. Call 334-614-6538 if needed.

Child InformationEnter each child’s name, age, school, and allergies below.

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Authorized Pick-Up ContactsOnly these individuals may receive meals with ID.

Child Information
Enter each child’s name, age, school, and allergies below.

Authorized Pick-Up Contacts
Only these individuals may receive meals with ID.