Meals on Wheels Signup

Registration for the coming distribution is now CLOSED. Pickup will be on WEDNESDAY, May 18th from 3:00PM to 4:30PM.

You may notice that the form has changed a little bit. We adjust the form as deemed necessary to stay in compliance with all state and federal regulations. Thank you for your understanding. We are glad that we are able to help keep this great service going.

Kosher Meals on Wheels and Chabad Southwest have partnered with Desert Torah Academy to bring Kosher Food Boxes back!
For those of you who don't know, these boxes are filled with kosher food and Cholov Yisroel milk, and they are available FREE to any household that has children aged 2 through 18 through the NSLP (National School Lunch Program) that is not receiving meals at the school their children attend.

They will be delivered once a week Wednesday afternoon. Pick up will be at Desert Torah Academy (1312 Vista Drive Las Vegas NV, 89102) entering from Del Ray St.

You will receive one box for every child in your house ages 2 thru 18. Each box contains 5 days worth of breakfast and lunch.

Rabbi Levi Wilhelm
Chabad Southwest Las Vegas

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Total Amount of Children Ages 2-18*

Name and age of Child #1*

Name and age of Child # 1*

Name and age of Child # 2*

Name and age of Child # 1*

Name and age of Child # 2*

Name and age of Child # 3*

Name and age of Child # 1*

Name and age of Child # 2*

Name and age of Child # 3*

Name and age of Child # 4*

Child # 1 Name and Age*

Child # 2 name and age*

Child # 3 name and age*

Child # 4 name and age*

Child # 5 Name and age*

Child # 1 name and age*

Child # 2 name and age*

Child # 3 name and age*

Child # 4 name and age*

Child # 5 name and age*

Child # 6 name and age*

Child #1 name and age*

Child #2 name and age*

Child #3 name and age*

Child #4 name and age*

Child #5 name and age*

Child #6 name and age*

Child #7 name and age*

Child #1 Name and Age*

Child #2 Name and Age*

Child #3 name and Age*

Child #4 name and age*

Child #5 Name and Age*

Child #6 Name and Age*

Child #7 Name and Age*

Child #8 Name and Age*

Child #1 Name and Age*

Child #2 Name and Age*

Child #3 Name and Age*

Child #4 Name and Age*

Child #5 Name and Age*

Child #6 Name and Age*

Child #7 Name and Age*

Child #8 Name and Age*

Child #9 Name and Age*

Which school do these children attend?*

List the school(s) your school-age children attend.*

Self Certify*

I certify, by checking off this box, that I am not receiving any other meals from Lunch Programs for my children who are receiving from this location.

I understand that filling out this form does not guarantee receiving meals. We will do our best to make sure we have your meals for you.

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