Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Carryout Meal Registration Form

  1. Bayfield County Department of Human Services
  2. This registration form should be filled out, printed, and brought to your first meal pick-up. Your information will not be saved or submitted online.
  3. Gender
  4. Race
  5. Ethnicity
  6. Is your income below the following Federal Income Guidelines?

    Federal Income Guidelines:

    1 person in home : $1,063/month, $12,760/year

    2 people in home: $1,437/month, $17,240/year

    3 people in home: $1,810/month, $21,720/year

    4 people in home: $2,183/month, $26,200/year

  7. Nutrition Risk Screening Questions:

    I have an illness or condition that made me change the kind and/or amount of food I eat.

  8. Leave This Blank: