Dear Parent/Guardian:
You do not have to complete this section of the form to get reduced price or free Child Nutrition Program benefits for your children. If you do not sign the Consent of Disclosure, it will not affect eligibility for or participation in the Child Nutrition Programs.
To save you time and effort, information about your children's eligibility for reduced price or free Child Nutrition Program benefits may be shared with other programs for which your children may qualify. For the program listed below, we must have your permission to share your information.
Yes, I DO want school officials to use the information provided above to determine eligibility to receive fee waivers for the following school fees I have checked below.
List all students, school, and grade below.
By entering your name below, you are signing this disclosure electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Consent for Disclosure.
*REQUIRED
If you click "submit" and do not get a THANK YOU screen the form did not successfully process, please try again or call Information Services at
316-554-2203.
For more information, you may call or email:
Gina Lee, Director of Nutrition Services
Phone: 316-554-2219 Email: ginalee@usd261.com
Address: Food Services, 132 Stewart Door #15, Haysville, KS 67060
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