Lake Dallas ISD Child Nutrition -Student Meal Account Restriction Form

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Use this form to help the Child Nutrition Department better control your child’s selections, spending, or both. A new restriction form must be turned in each school year. Restrictions will NOT carry over to the next school year.

Email *

Please enter today's date *

YYYY

Student's Full Name *

Student Campus *

LDHS

LDMS

LDE

SSE

Required

Grade Level *

Parent/Guardian Name *

Please choose how you would like to RESTRICT your student's meal account.

Tray only (only meals can be purchased)

No Breakfast

No snacks or extras allowed

Cash only for snacks - student may not charge lunch account for snacks, cash in hand

Snacks only on certain days (use "other" to specify day)

Other:

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. * *

I Accept

A copy of your responses will be emailed to the address you provided.

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