At Risk Site Sign Up – Southwest Human Resource Central Kitchen

At Risk After School Program Site Info Sheet

Site Number

New Site

Yes No

Site Name

Site Address

City

State

Zip Code

Site Phone Number

Site Contact Name

Site Contact Phone Number

Site Contact email

Alternate Phone Number

Alternate Phone Numbers

Tax Status

For-Profit Non-Profit Public Other

Nearest School:

Ages: From

Date of Services Beginning

Ending

Months of Operation

Days of Operation

Hours of Operation Open

Hours of Operation Close

Time Breakfast

Meal Time Lunch

Meal Time Snack

Meal Time Supper

Number of enrolled participants

Free

Reduced Price

Paid

Total

2024-2025 Sponsor/Site Agreement for the At Risk Afterschool Program

Name of Site

Address of Site

Site Supervisor

Phone Number

The person named above agrees to, 1. Attend annual sponsor training session. 2. Comply with Civil rights laws and regulations. 3. Serve meals to all children 18 years of age and under (or persons 19 and over who are mentally or physically disabled and participating in a public nonprofit school program for the mentally or physically disabled). 4. Serve meals that meet minimum meal pattern requirements. *Snacks (2 components) Supper (5 components) call Central Kitchen and Central Office immediately if any items are missing. 5. Provide adequate supervision during the meal service. * Attendance should be first and separately from meal counts. *Meals are to be marked as they are served. 6. Maintain and submit promptly such reports and records that the sponsor requires. *Return completed meal count sheets at the end of the week, no later than the following Monday. 7. Report any problems regarding the meal services. *Contact the Central Kitchen and Central Office with any issues. 8. Report to the sponsor any changes in the dates of services, meal service times and/or the number of meals required as attendance fluctuates. Example: If sites attendance in the number of children attending, the number of meals ordered should decrease. If site decides to close or not order meals, contact the Central Kitchen 3 days prior or as soon as your site has knowledge of closings.

Dates of Service:

Times:

Number of Meals

I understand that if any of the above information changes, I must notify SWHRA at least 3 days before the (Change(s) go into place.

Site Supervisor Signature

Sponsor Signature

Principal Signature