Kids Cafe School Year Program

All program sites wishing to participate in the Child and Adult Care Food Program (CACFP) must complete a new Site Information sheet every program year. Please fill out the following information.

Is your site new or returning?

NewReturning

Site Name	Address Line 1	Address Line 2	City	State	Zip	County

Primary Contact Person

First Name	Last Name	Phone	Email	Title	Is this the Site Supervisor?
					Is this the Site Supervisor? YesNo

Secondary Contact Person

First Name	Last Name	Phone	Email	Title	Edit this text
					Is this the Site Supervisor? YesNo

Site Service Dates and Times

Operating Hours Start Time

Operating Hours End Time

Age Range of Participants

Number of children expected for Lunch

Lunch serving start time

Lunch serving end time

Number of children expected for PM Snack

PM Snack serving start time

PM Snack serving end time

Number of children expected for Supper

Recommended at beginning of enrichment program - 1 hour (Until 6:00pm)

Supper serving start time

Supper serving end time

What kind of enrichment programs are provided?

Closures, please use specific dates (Including Thanksgiving, Winter Break, Spring Break)

Referred By (optional)

Name of the recruiter who referred you to Houston Food Bank.

Monday	Tuesday
Wednesday	Thursday
Friday	Saturday
Monday - Friday