Summer Food For Kids Registration

We look forward to serving your family this summer. If you need assistance registering, please contact us at (252) 261-2756.

Your Information

Do you live or work in Dare County?

If you do not live or work in Dare County, please call 252-261-2756.

Are you able to pick up in Kitty Hawk or Rodanthe?

Preferred language

Have you ever participated in this program in the past?

First Name

Last Name

Date of Birth

Race — choose all that apply

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

Physical Street Address

City/Town

Cell Phone Number

Numbers only. No dashes.

May we text you?

Email Address

Employment Status

Are you currently receiving food stamps?

If you are not receiving food stamps, why?

Proof of Dare County residency/employment

Do you have a Spouse/Partner?

Spouse/Partner Information

Spouse First Name

Spouse Last Name

Spouse Date of Birth

Spouse Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

Spouse Employment Status

Do you have children under 18 in your home that you wish to register for?

How many children?

If you have more than 7 children under 18 years old that you wish to register, please call our office at 252-261-2756 for instructions.

Child #1

Child #1 First Name

Child #1 Last Name

Child #1 Date of Birth

Child #1 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #1

Child #2

Child #2 First Name

Child #2 Last Name

Child #2 Date of Birth

Child #2 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #2

Child #3

Child #3 First Name

Child #3 Last Name

Child #3 Date of Birth

Child #3 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #3

Child #4

Child #4 First Name

Child #4 Last Name

Child #4 Date of Birth

Child #4 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #4

Child #5

Child #5 First Name

Child #5 Last Name

Child #5 Date of Birth

Child #5 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #5

Child #6

Child #6 First Name

Child #6 Last Name

Child #6 Date of Birth

Child #6 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #6

Child #7

Child #7 First Name

Child #7 Last Name

Child #7 Date of Birth

Child #7 Race

American Indian/Alaskan Native

Asian/Native Hawaiian/Pacific Islander

African-American/Black

Caucasian/White

Hispanic/Latino

Other

ID for Child #7

Beach Food Pantry Summer Food For Kids Registration

Your Information

Spouse/Partner Information

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

Child #7