Finger Scan Opt Out Form

Student Name: _____________________School:__________

I request that the above named student(s) not participate in the Finger Scan Identification program.

Parent Signature: ________________________

Date: ________________

Return this form to the Food Service Office located at Carroll High School, 3701 Carroll Road, Fort Wayne,IN 46818 Attention: Leeanne Koeneman

The USDA is an equal opportunity provider and employer.