Meal Delivery Request (Distance Learning Day)

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Use this form to request meal deliveries during Distance Learning Days. By completing this form, you are giving your consent for meals to be delivered to your home via bus on LCSD scheduled Distance Learning Days from 11am - 1pm.

This institution is an equal opportunity provider.

Email *

Student First Name *

Student Last Name *

School *

Clarkdale

Northeast Elementary

Northeast High

Northeast Middle

Southeast Elem./High

Southeast Middle

West Lauderdale Middle/High

West Lauderdale Elementary

Other:

Required

Parent/Guardian Name *

Parent/Guardian gives permission to deliver *

Yes

Delivery address *

Send me a copy of my responses.

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