MAK COMMUNITY

Site Name *

Site Address *

Site Owner Name *

Site Contact Name *

Site Email Address *

Site Confirm Email Address *

Site Contact Phone Number *

What are the hours of operation of your site? *

Does your site have 2 or more shifts? If so, what are the hours? *

What meals to you need service for? (Please check all that apply) *

What type of site do you operate? (Please select one) *

Closed Enrolled

Closed Restricted

How many children are enrolled in your site? *

Does your site have a kitchen? If yes, does your kitchen have a Food Service License?? *

Yes

No

Does your site have a Food Beverage License? *

Yes

No

Is your site currently or has it previously been affiliated with any other sponsor? *

Yes

No

Please indicate the programs your site is interested in participating in by checking all boxes that apply. *

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