How to Enroll

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Mecklenburg County > Health Department > Healthy Futures > How to Enroll

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Healthy Futures Starting in the Kitchen Application

Childcare cooks for 3, 4, and 5 star centers and centers in a residence located in Mecklenburg County can apply for this free program.

Please fill out the form below to request enrollment. Optionally, you may download the application and mail it to our office.

Facility Name Street AddressCityStateZip Facility Email AddressFacility PhoneFaxFacility Director or Owner Food Service Vendor

Facility Description

Facility Type (Check one)Child Care Facility
Center in a ResidenceStar Rating Years in business # aged 0-5yr enrolled # receiving child care subsidy Do you participate in CACFP?Yes
No

For the FOOD PREPARATION PROVIDER to complete.
You must ANSWER ALL QUESTIONS for the application to be considered.

How will this program help the children in your facility? Why is it important for you to attend this training?By typing my name below, I realize the value of Healthy Futures Starting in the Kitchen to my facility, the children and their families and my career and will to the best of my ability attend all five sessions of the program.

Foodservice Provider Date

For the CHILD CARE ADMINISTRATOR to complete.
You must ANSWER ALL QUESTIONS for your application to be considered.

Please confirm the following statements if you agree.

I agree to support my foodservice provider’s participation in Healthy Futures Starting in the Kitchen by making it possible for him or her to attend the weekly sessions.
I agree to provide a substitute (if needed) for the foodservice provider’s responsibilities while he/she is attending the program.
I agree to pay for my facility’s foodservice provider’s hours during his or her participation in Healthy Futures Starting in the Kitchen.
I agree to share our facility menus pre-and post- training.
I agree to encourage my foodservice provider to implement what he or she has learned in the program.
I agree to assist my foodservice provider to get the surveys completed and returned to the Health Department in a timely manner.If you cannot agree to any of the above statements please explain here:How will you support your food service provider’s efforts in implementing what he or she has learned in the program?
By typing my name below, I acknowledge I have read the application including program expectations and will, to the best of my ability, adhere to them.

Facility Director/Owner Date

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Healthy Futures Starting in the Kitchen

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