AtlantiCare Summer Lunch & Learn Program 2022

For children ages 3-18 and parents/guardians

June 28th - August 25th, 2022
Tuesdays & Thursdays
11:30 am - 1:30 pm

AtlantiCare HealthPlex

1401 Atlantic Ave
Atlantic City, NJ 08401

Question Title

* Please answer all questions:

Parent/Guardian Last Name:

First Name:

Address:

Apartment:

City:

State:

ZIP:

Email Address:

Phone Number:

List Additional Parent/Guardian and Phone Number:

Question Title

* Preferred method of contact?

Phone

*NEW* Sign up for text message alerts for the Summer Lunch and Learn program.

Text SUMMER22 to 79422 (Message and data rates may apply)

Receive reminders for the program and alerts in case of cancellations due to weather.

Question Title

* Program Guidelines:

I understand that all children and adults must attend in-person to receive a lunch meal and all meals must be eaten on-site. There will be no grab-and-go lunch meals this summer.

I understand that in accordance with Covid-19 guidelines, if any member of my family including myself feels sick or has been exposed to Covid-19, we will stay home and not attend the Summer Lunch and Learn Program.

Question Title

* How many children will be attending our program this summer?

Question Title

* My child/children: (Check all that apply.)

Has a Pediatrician

Has seen a Pediatrician/Doctor in the last 12 months

I need help making an appoinment for my child/children.

Question Title

* Pediatrician's Name: