Distance Learning Day Lunch Request

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We would like to continue to provide breakfast and lunch service for students who need it on distance learning days. To that end, we will provide a breakfast and lunch to take home the day BEFORE the distance learning day. They will be distributed right before the end of the day to maximize freshness. By filling out this form, you are indicating that you would like your student to receive these meals. Please fill out one form for EACH student who requires meal service. You may also use this form to cancel a previous meal request. (This institution is an equal opportunity provider.)

Student First Name *

Student Last Name *

Student Grade Level *

Preschool

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Student's Teacher *

Please mark one *

Please provide meal service to my student for distance learning days.

Please cancel my student's request for meal services.

Allergies?

Does your student have allergies or special dietary needs? If not, please leave blank.

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