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2018-2019 Backpack Buddy Program Agreement

School Name School District Address Line 1 Address Line 2 City County State Zip
First Name  Last Name Job Title Phone Email
Primary School Coordinator
First Name  Last Name Job Title Phone Email
Secondary School Coordinator

First Name  Last Name Phone Principal Email

Backpack Buddy Allotment Information

Backpack Buddy Background Verification Form

Please include the names of the Backpack Buddy school coordinator’s that will have direct contact with children for the Backpack Buddy program.  The primary coordinator’s name should be included in table below.  Also, include any volunteers that will help with the program and have access to children on a regular basis, which includes anyone that helps give out the bags to the children on a regular basis.
Site Program Participant Name Type

The Agreement

This document is an agreement made between the Houston Food Bank (hereinafter referred to as “HFB”)
located at 535 Portwall St. Houston, TX 77029 and your school (hereinafter referred to as “School Partner”).

The School Partner agrees to:

1.       Ensures the School Partner staff complies with all applicable local, state, and federal statutes, ordinances and regulations including, but not limited to, the safe and proper handling of food and distribution of food.

2.       Willingness to abide by the policies, procedures, and record keeping requirements of HFB.

3.       School Partner staff and volunteers will not engage in discrimination, in the provision of services, against any person because of race, color, citizenship, religion, gender, national origin, ancestry, age, marital status, disability, sexual orientation including gender identity or expression, unfavorable discharge from the military, or status as a protected veteran.

4.       Ensure that all student participants have a signed permission slip.  Supply HFB with copies of permission slips as students are added to the program.  All Backpack Buddy records should to be stored for a minimum of three years at the School Partner location.

5.       Distribute healthy, nutritious food to children free of charge.

6.       Identify children that are chronically hungry in your school(s) using the guidelines specified in the Student Referral Form, as indicated in the Backpack Buddy Informational Packet.

7.       Participating children must meet income eligibility with either receiving free or reduced lunch at school or have a letter of extreme circumstances or economic hardship(s) written by parent or School Partner Coordinator.

8.     Identify any food allergies that the enrolled child may have (peanuts, milk, etc.).  Flag their name so that those items will not be distributed to them once sent to the school.  Contact the Backpack Buddy Manager for specific food allergy procedures.

9.       Distribute food sacks each week (on Friday’s, unless otherwise specified due to holidays or school closures) to children with completed permission forms on file.

10.   Provide food sacks a minimum of three (3) times a month while the program is in operation.

11.   Store the food sacks six (6) inches off of the floor, six (6) inches away from the wall, and six (6) inches below the ceiling.

12.   The food should be kept in a secure place that is sanitary, temperature controlled, and away from cleaning materials and toxic chemicals.

13.   Keep accurate records.  Prepare, submit, and adhere to the electronic monthly report system operated by HFB each month by the 1st of the next month.

14.   Please have the School Partner Coordinator available for an on-site monitoring visit at least once every year from HFB staff or HFB certified volunteer.

15.   Ensure School Partner staff and volunteers with direct repetitive contact with children pass a national background check, as indicated in the Backpack Buddy Informational Packet.

16.   At least one School Partner representative will need to receive yearly food safety training.  HFB will provide the training to the School Partner Site Coordinator via an online tool.  If the trained person leaves the school, please notify HFB to schedule a new training.

17.   If you would like to add additional children within your max allotment, please ensure you are following the criteria as specified in the Student Referral Form, have a permission form on file, and continue communicating to the child that they will be eligible only through the end of the school year or June 7, 2019.

18.  Program agreement to be submitted yearly by the School Partner with updated contact information and allotment numbers to continue the program.

19.   If School Partner is contacted by any form of media to discuss the Backpack Buddy program, please contact the Backpack Buddy staff before granting any interviews.

20.   Notify Backpack Buddy staff immediately if School Partner Site Coordinator’s contact information changes during the school year.

21.   For any questions that you may have in reference to the program, please contact Backpack Buddy staff.

22.   Display the “And Justice for All” poster in the location of food distribution (i.e., School Partner Site Coordinator’s office or nurse’s station).

Principal Signature

BOTH you and your principal are required to provide e-signatures for this application to be considered.

An email message will be sent to the Principal email that you provided. Your Principal must click the link and follow the instructions to provide their signature.