To be completed by the parent or guardian only.
The information you provider will be treated confidentially and will be used only for CACFP purposes

I wish to enroll my child/children whose names and enrollment information are given in the USDA Child and Adult Care Food Program which reimburses child care providers for serving nutritious, well-balanced meals to day care children. I understand my child/children will receive meals at no extra charge to me when they are in care during any of the scheduled meal services. I have received a copy of The child and Adult Care Food Program information  sheet which explains the goals of teh CACFP. I understand the day care home cannot and will not discriminate for reasons of race, color, national orign, age, or disability.  

    SVDP USDA Child and Adult Care Food Program  Enrollment Form

    Hours in care
    Although you are not required to provide the following information, your cooperation will help determine compliance with Federal Civil Right Laws. In no instance will this information, whether provided or declined, be used in considering your application. We are authorized to ask for this information under Title VI of the Civil Rights Act of 1964, Collection of this information is strictly for statistical reporting requirements.  Please check correct categories below:
    By emailing this enrollment, I certify the information supplied is correct and I am this child's Parent or Guardian.