1. Columbus Recreation and Parks
2010 Summer Lunch Program Agency Application
(Please complete ALL information requested or application will be voided)
Agency Name
Agency Address
Site Address
Phone Number at Lunch Site
Contact person name, phone number & email address
School nearest the Lunch Site
***Federal 501c3 Verification #
Lunch Program sites must operate a minimum of 6 weeks of the program. The Summer
Food Program operates from June 7th – August 20th .
Will your program be Open (to the public) or either Closed Enrolled (Participants
have to enroll for your program)? (Circle One) OPEN or CLOSED ENROLLED
List your dates of operation_______________________________________
Check your program’s days of operation:
Monday Tuesday Wednesday Thursday Friday
Meal serving’s times must be a minimum of 3 hours apart. Please number your first
three choices for meal times. You must have a 3 hour break between meals. If the time
you need isn’t listed please add it.
Breakfast Lunch PM Snack
7:30-8:00 11:00-11:45 5:00-5:30
8:00-8:30 11:45- 12:30 5:30-6:00
8:30-9:00 12:30- 1:15 6:00-6:30
9:00-9:30

2. Earliest time that you can receive deliveries
Time your program opens for children
Approximate number of children you will be serving daily
(Minimum of 30 required)
Number of children that can be fed indoors
Is Refrigeration available for lunches? Yes No
Number of Adults present during meal time’s _________
How late is facility open for children each day? ________
Describe the activities available for children
Please list the two closest side streets to your facility
**** You must attach a copy of your Agency Proof of Liability
Insurance and a copy of your 501c3 verification to this application. If
the forms are not received by the deadline date the application’s
approval may be delayed.
I hereby agree to commit to the serving times and dates noted in this application. I accept
all terms and conditions required by the Summer Lunch Program of Central Ohio.
Signature Date
Return this application by March 22nd to:
Summer Lunch Program
Columbus Recreation and Parks Department
ATTENTION: Kay Snyder
1111 East Broad Street
Columbus, Ohio 43205