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Goldberg's Bagels Order Form
When: Mondays - Thursdays (except early dismissal)
Where: SES Cafeteria
Contact us at
hsa@sainte-school.org
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* Indicates required question
Email
*
Your email
Name:
*
Your answer
Student 1 Name:
*
Your answer
Student 1 Grade:
*
Choose
PK3
PK4
K
1
2
3
4
5
6
7
8
Student 1 Order:
*
Plain Bagel ($1.00)
Plain Bagel w/ Butter ($2.50)
Plain Bagel w/ Cream Cheese ($3.00)
Rainbow Bagel ($1.00)
Rainbow Bagel w/ Butter ($2.50)
Rainbow Bagel w/ Cream Cheese ($3.00)
Gluten-Free Bagel ($1.50)
Gluten-Free Bagel w/ Butter ($4.00)
Gluten-Free Bagel w/ Cream Cheese ($5.00)
Student 1 Days to Deliver:
(The item selected above will be delivered on all days selected below. If you want different items delivered on different days, please fill out another form for that day.)
*
Monday
Tuesday
Wednesday
Thursday
Required
Student 2 Name:
Your answer
Student 2 Grade:
Choose
PK3
PK4
K
1
2
3
4
5
6
7
8
Student 2 Order:
Plain Bagel ($1.00)
Plain Bagel w/ Butter ($2.50)
Plain Bagel w/ Cream Cheese ($3.00)
Rainbow Bagel ($1.00)
Rainbow Bagel w/ Butter ($2.50)
Rainbow Bagel w/ Cream Cheese ($3.00)
Gluten-Free Bagel ($1.50)
Gluten-Free Bagel w/ Butter ($4.00)
Gluten-Free Bagel w/ Cream Cheese ($5.00)
Clear selection
Student 2 Days to Deliver:
(The item selected above will be delivered on all days selected below. If you want different items delivered on different days, please fill out another form for that day.)
Monday
Tuesday
Wednesday
Thursday
Student 3 Name:
Your answer
Student 3 Grade:
Choose
PK3
PK4
K
1
2
3
4
5
6
7
8
Student 3 Order:
Plain Bagel ($1.00)
Plain Bagel w/ Butter ($2.50)
Plain Bagel w/ Cream Cheese ($3.00)
Rainbow Bagel ($1.00)
Rainbow Bagel w/ Butter ($2.50)
Rainbow Bagel w/ Cream Cheese ($3.00)
Gluten-Free Bagel ($1.50)
Gluten-Free Bagel w/ Butter ($4.00)
Gluten-Free Bagel w/ Cream Cheese ($5.00)
Clear selection
Student 3 Days to Deliver:
(The item selected above will be delivered on all days selected below. If you want different items delivered on different days, please fill out another form for that day.)
Monday
Tuesday
Wednesday
Thursday
Please make check out to
Saint Elizabeth School HSA
. Check amounts should be calculated as follows:
Check amount =
Total Item Prices
x
# of days per week
x
13 weeks
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