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Breakfast/Lunch Request Form
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* Indicates required question
Are you interested in receiving a free lunch/breakfast? ( all children age 1 year to 18 years old qualify for a free meal)
*
Yes
No
Names of children you want meals for:
*
Your answer
Meal Delivery: Will you be doing curb-side pickup in front of the Grade School, or require rural delivery within the school district boundaries? Child must be present to receive meal, however, child may receive meal without adult present.
*
Pick Up
Delivery
If requesting delivery, what is your delivery address:
Your answer
Please check which days you are requesting meal(s).
*
March 18
March 19
March 20
March 23
March 24
March 25
March 26
March 27
Required
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This form was created inside of Valley Falls USD 338.
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