Food Program School Age Verification for Child 5 years -Licensed Provider

Your Six-Digit WECA CACFP Provider Number

Your First and Last Name

Child's Number

Child's Name

Child's Date of Birth (MM.DD.YYYY)

I certify that this child is 5 years of age, enrolled in full-day school, and in my care no more than 3 hours per day. I certify that this child is 5 years of age, enrolled in full-day school, and in my care no more than 3 hours per day. Yes