Summer EBT Opt-Out

What would you like to do?

Completing this form means you DO NOT WANT TO RECEIVE SUMMER EBT BENEFITS.

All fields marked with * are required

Parent First Name *

Parent Last Name *

Email Address *

Phone Number *

Children Details

First Name *

Last Name *

Date of Birth *

School *

School District

Add Child

Summer EBT opt-out has been submitted.

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