Food Permission From

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Food Permission From - BOMB POP

To celebrate our House Wars Activity Day Tuesday, May 30th (rain date May 31st) students will have the opportunity to enjoy a sweet treat.

*Company Phone Number and/or Email: The BOMB POP Company #(800) 331-0830.
If you have specific questions regarding food ingredients, please contact the company directly.

In the event we have not received the Google Form, your child will not be able to participate in the event.

If you have more than one student at Pequea Elementary, please complete one form for each student.

BOMB POP

Nutrition Information

Specifications

Student Name (first & last) *

Student Grade/Class *

AM - Kindergarten

PM - Kindergarten

K-1 Campo

1 - Drexel

1 - Snyder

2 - Szentesy

2 - Walker

2-4 Vanleuvan

3 - Allen

3 - Eshleman

4 - Iddings

4- Orzolek

5 - Haverstick

5 - Rote

5-6 Gutierrez

6 - Sarra

6 - Miller

Parent Permission *

I have reviewed this information and I give my permission for my student to eat the BOMB POP.

I have reviewed this information and I do not give my permission for my student to eat the BOMB POP.

I have reviewed this information and my student may only eat a safe snack that I will provide from home.

My child has diabetes, please indicate if you want your child to cover/bolus for snack. In addition, please list the total carb count for the cover/bolus.

If you are choosing to cover and your child does not have an insulin pump, please specify the units of insulin coverage.

If your child has an insulin pump, the pump will dictate the bolus.

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