Clone of Feeding South Florida's 2025 Summer BreakSpot Interest Form

Please complete this form if you are a community agency in Palm Beach, Broward, or Miami-Dade Counties interested in becoming a Summer BreakSpot site in 2026.

Agencies selected to participate in Summer BreakSpot will receive meals from Feeding South Florida as your sponsor to distribute nutritious meals during specified meal times. Agencies will elect to receive 2 out of the 3 available meals consisting of either breakfast and lunch, or lunch and afternoon snack for children ages 0-18.

Agencies must have at least two individuals available during each distribution time and will regularly provide meal counts/reporting information to Feeding South Florida on a daily basis.

Please note this is an interest form and submitting this application is not a guarantee or confirmation that FSF will provide the Summer BreakSpot Program to your Organization.

We are all part of each other's success!

To learn more about Feeding South Florida, visit our website: https://feedingsouthflorida.org/ .

QUESTIONS?
Please contact:
Xavier Parker: email- xparker@feedingsouthflorida.org or call 954.518.1818 x1815, OR
Adriana Moncada: email- amoncadax@feedingsouthflorida.org or call 954.518.1818 x1827.

Contact Person Name

First NameLast Name

Contact Person Email

example@example.com

Agency/Organization Name*

Agency/Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

What type of organization will run your summer programs? (For-profit organizations may qualify if they are open to the public.)*

Non-proft organizationFor-profit company

Does your organization/site currently operate any government meals programs under the Child Care Food Program? (Afterschool Meals, National School Lunch Program, Summer Meals, etc.)*

YesNoUnsure

Describe your Site (select closest description)*

Do you operate multiple sites*

YesNo

If yes to previous question, how many sites?

What is the age range of children will you expect to serve (Age 0-18)?*

Days of the week will your program expect to serve (select all that apply):*

Do you plan on having field trips?*

YesNo

Do you have food storage equipment for field trips? (e.g. coolers)*

YesNoN/A

Are you planning any closures during the program? (Select all that apply)

JuneteenthJuly 4thN/AOther

What date may your program begin meal services? (As early as...)*

What is the last date your program may provide meal services? (Not after...)*

Do you have on-site access to refrigeration?*

Have your volunteers/staff passed background checks?*

YesNo

Approximately how many children do you anticipate serving per meal? *

Which meals do you expect to serve during your Summer Program? (Please select ONLY 2)*

BreakfastLunchAfternoon Snack

Who will be your Site Supervisor?*

First NameLast Name

Position/Title of your Site Supervisor*

Email Address for your Site Supervisor*

Phone Number for your Site Supervisor*

Area CodePhone Number

Who do you expect to be your ALTERNATE Site Supervisor?*

First NameLast Name

Position/Title of Alternate Site Supervisor*

Email address for Alternate SiteSupervisor*

Phone number for Alternate Site Supervisor*

Area CodePhone Number

Feeding South Florida's Summer BreakSpot Application