CACFP Week Registration Form - Child and Adult Care Food Program

Name*

First Last

Title

Email*

Organization Name*

Write N/A if not an organization.

Address*

Street Address Address Line 2 City State ZIP Code

Type of Participant*

Adult Day Care Center
At-risk Afterschool Program
Child Care Center
Emergency Shelter
Family Day Care Home
Head Start/Early Head Start
Outside School Hours Care
Other

Number of Participating Centers*

Estimated Number of Participants*

Planned activities for the week (check all that apply)*

Nutrition educational activities
Cooking/meal preparation education and/or activities
Breastfeeding Friendly Designation Program participation/presentation
Farm to CACFP educational activities
Attending daily virtual events
Snap Your Snack!
Other

If other, please describe:

Promotional Plans*

Use #VACACFP and find us @CACFPVirginia on Facebook, Instagram, and Twitter.

Social Media
Organization's Website
Other Promotional Method
We don't plan on promoting this

Please have @CACFPVirginia follow my organization on social media.*

Yes
No

My organization gives permission for the Virginia Department of Health and Virginia Department of Education to share, re-tweet, re-post, etc. our social media content.*

Yes
No

We’d like to be your friend on social media! Share your Website, Facebook, Instagram and/or Twitter handles with us:

Facebook

Instagram

Twitter

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