Child and Adult Care Food Program

Child and Adult Care Food Program

  • Dear parents / Guardian,
    Your day care facility participates in the U.S. Department of Agriculture child and Adult Care Food Program. CACFP needs verification of enrollment of each participant in the facility. Please Complete the information below for all participants in your household that are enrolled at the facility. The information below should be completed by the parent or guardian.
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  • For Facility / Provider Use Only:

    in accordance with the Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. To file a complaint of discrimination, write USDA, Director, Office of Adjudication, 1400 Independence Ave, SW, Washington, D.C. 20250-9410 or call (866) 632-9222. Individuals who are hearing impaired or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.
  • For State Use Only: