LFNO Week 3 Meal Service Request Form (9/8-9/11)

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**You do not need to complete this form if you will not be participating in LFNO Meal Services for Week 3.**

Please complete this form for EACH STUDENT you are requesting a meal kit for.

Week 3 Pickup Windows: Tue, Sept. 8th (10am-2pm) AND Wed., Sept. 9th (10am-2pm)

Note: Unless you qualify for Free Lunch, prepayment is required prior to picking up meal kit(s) via MySchoolBucks or check.

Email *

Student First Name *

Student Last Name *

Grade Level *

I am requesting a meal kit for Week 3 of LFNO Virtual Learning (9/8-9/11). *

yes

Who will be picking up meal kits for you student? (Note: Students are not required to be present for pickup, but parents, guardians, or designated adults must fill out a consent form with student information for each meal kit being picked up.) *

Parent or guardian

Other:

Do you have any dietary restrictions? Yes or No. (If yes, please specify.)

I understand that unless I qualify for "Free Lunch" that am required to PREPAY for weekly meal kits via MySchoolBucks or mailed check. *

Yes

Required

Please provide any feedback you have about Meal Services for 2020-21. (optional)

Send me a copy of my responses.

Submit

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