At this time, PCS Breakfast-to-go will be distributed at the end of the school day. Meals should be refrigerated when students arrive home and consumed the next morning. Classroom deliveries happen between 2-2:25 pm. Parents of children seeking a Breakfast-to-go, are asked to complete this form.

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Please fill out one survey per family for students enrolled at PCS. Morning PK students eat breakfast at school shortly after coming to school, so their information is not needed in this form.

NOTE: Breakfast-to-go is again FREE for all students under a federal food service program waiver. Please call 315-826-0216 if you want to cancel breakfast. Otherwise, a child will receive a daily delivery. Thank you!

Email *

Name of Parent/Guardian completing this form: *

First and Last Name of PCS child #1 to receive breakfast. *

Grade Level of PCS child #1: *

First and Last Name of PCS child #2 to receive breakfast.

Grade Level of PCS child #2:

First and Last Name of PCS child #3 to receive breakfast.

Grade Level of PCS child #3:

First and Last Name of PCS child #4 to receive breakfast.

Grade Level of PCS child #4:

First and Last Name of PCS child #5 to receive breakfast.

Grade Level of PCS child #5:

If a student on your form attended PCS last year and has now developed a food allergy OR IF A STUDENT on your form IS NEW to our district, please provide food allergy information here:

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