Our Neighbors' Place Backpack Program

High School Student Sign Up Form


Dear Parents,
We know the struggling economy is taking its toll on families in our community. Increased homelessness and rising numbers of families using the food pantry have raised our concern that some of our families may need food assistance on the weekends. To that end, in collaboration with the River Falls School District, the Salvation Army of Pierce County, and the River Food Pantry, Our Neighbors’ Place (ONP) would like to offer a source of groceries over the weekend for low income families and/or families experiencing financial hardship.

Through the ONP Backpack Program, a bag filled with nutritious, kid-friendly food items from all the food groups can be picked up by a parent each week during the school year and from Our Neighbors’ Place’s Day Center, located at 122 West Johnson Street, between the hours of 11:00 and 4:00 Monday through Thursday. Other arrangements can be made.

Families may join the program at any time throughout the school year.

Please complete the form below to enroll your child.
— Jay Matchett, Executive Director

Please complete and submit one form per family below:

I want our family to receive food from the ONP Backpack Program for each school-aged child listed below who is not already enrolled in the program at one of the elementary schools or Meyer Middle School. *
Guardian/Parent's Full Name *
Guardian/Parent's Full Name
Guardian filling out form.
Please select one.
Guardian/Parent's Date of Birth *
Guardian/Parent's Date of Birth
Please select one
Guardian/Parent's Race
Please select all that apply.
Select one.
2nd Guardian/Parent's Full Name
2nd Guardian/Parent's Full Name
If applicable.
If applicable.
Date of Birth (2nd Guardian/Parent)
Date of Birth (2nd Guardian/Parent)
If applicable.
Race (2nd Guardian/Parent)
If applicable.
If applicable.
Address *
Address
Phone *
Phone
Child's Name (Child 1) *
Child's Name (Child 1)
Please select one.
Please select your child's school.
Birthdate (Child 1) *
Birthdate (Child 1)
Race (Child 1)
Please list all that apply.
Please select one.
Name (Child 2)
Name (Child 2)
Please select one
2nd Child's Grade
Please select your child's school.
Birthdate (Child 2)
Birthdate (Child 2)
Race (Child 2)
Please check all that apply.
Please select one.
Name (Child 3)
Name (Child 3)
Please select one.
Please select your child's grade level.
Please select your child's school.
Birthdate (Child 3) *
Birthdate (Child 3)
Please select all that apply.
Please select one.
How many people live in your household (including children)?
Annual Household Income *
Please check one.
Do you currently participate in the following programs? *
Please check one.
Please select one.