HomeMy WebLinkAboutEnrollment FormFLORIDA DEPARTMENT OF EDUCATION
FOOD AND NUTRITION MANAGEMENT
SUMMER FOOD SERVICE PROGRAM FOR CHILDREN
CAMP ENROLLMENT VERIFICATION FORM
Sponsor Name City of Miami /Parks &Rec. Agreement Number 04-0899
Address 444 S.W.Avenue Rt -h Feer
Miami, Florida
Zip Code 33130
Telephone (305 ) 416-1308 Date February 12,2010
Residential Camp Yes Non-residential Camp Yes
Dates of Total Children Number of Children
Encampment Enrolled Eligible for
Reimbursement
6/14/10 - 8/13/10 3,399 3,399
Signature of Sponsor or Representative
S FS P -S4 `�,