MDE Office of Child Nutrition Revised 4/10/2020
Application to Participate in Waiver to Allow Parents and Guardians to Pick
Up Meals for Children During Unanticipated School Closures
SPONSOR: _________________________________________________________________
Waiver Request Applies to: ALL SITES SELECTED SITES (list below)
List of Sites:
Provide a description of the Parent/Guardian Meal Pick-Up System and how it will ensure that:
1) Meals are only distributed to parents or guardians of eligible children
2) Duplicate meals are not distributed to any child
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The following plan will be used only FOR PARENTS REQUESTING TO PICK UP MEALS WITHOUT
CHILDREN PRESENT. Parent/Guardian(s) will complete the Parent Pick-up Request Form. District staff will
validate the information through visual observation of children, use of the Eligibility software package when
possible, or inspection of documents that confirm the number of eligible children. The “Sponsor Signature”
confirms that the authorized employee has validated the information provided by the parent.
The district will maintain the approved Parent Request forms and create a roster that contains the Roster
number, name(s) of parent/guardian(s), and names of students. Forms will be sent to the Central
office/Administration site daily. The roster will be maintained at the Central office and will not be kept at the
individual sites. The Roster will be used to prevent adults from applying for Parent Pick up multiple times, at
multiple sites, and/or receiving multiple Dashboard Signs.
When a car with a Dashboard Sign arrives, the CN employee will mark the appropriate number and type of
meals on the daily meal count form that are indicated on the Dashboard Sign and provide that number of meals.
Staff will report to their supervisor if they believe duplicate meals are being served. Staff will report any
suspected instances to a supervisor to resolve and will not deny meals to a family.
MDE Office of Child Nutrition Revised 4/10/2020
By checking I acknowledge that information regarding the implementation of this waiver
must be reported to the State Agency after the emergency feeding program ends. A template
will be provided by the Office of Child Nutrition
_______________________________________________
Name of Authorized Sponsor Representative Submitting Form
_______________________________________________
Title of Authorized Sponsor Representative Submitting Form
___________________________
Date Submitted
STATE AGENCY USE ONLY
_________________________________________________
Approved by
___________________________
Date Approved: