Lunch Extras Permission Form
Students in grades Pre K - 6th grade have the option to purchase extra items in the cafeteria with parent permission. Please fill out this form to allow or deny your student(s) the opportunity to purchase extras. Each student in the household should be listed and given permission separately on this form.

Below are some of the items offered and their prices.   

*items are subject to change due to state regulations 

Sandwich/main entrée $2.20 

Fruit/Vegetable/Dessert $1.00

Juice Cup $0.50 

Yogurt $1.00 

Chips $1.00 

Milk $0.50 

Cookies $1.00 

French Fries $1.50 

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What school does your student(s) attend? *
Student 1 - First and Last Name *
Student 1 - Permission to Purchase Extras *
Student 2 - First and Last Name
Student 2 - Permission to Purchase Extras
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Student 3 - First and Last Name
Student 3 - Permission to Purchase Extras
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Student 4 - First and Last Name
Student 4 - Permission to Purchase Extras
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Student 5 - First and Last Name
Student 5 - Permission to Purchase Extras
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