PJ Park Lunch Meals: June 2024
Please submit a separate form for EACH child.
(Example: families with 4 children submit 4 separate forms.)

Daily lunch meals will be served at Paperjack Park in June to any child 18 years old or younger!!!
*Serving lunch meals Monday - Friday, June 10 - 28, 2024 11:30-12:15. (1 meal per child, per day):


Meals are FREE for those that are free/reduced. We encourage all families to apply to see if they can get the free rate.
Meal prices for paid status students are as follows:
Lunch- $3.00

We will be offering regular, fun activities for kids during lunch times!!!

Contact: 
Nikke Hafemeyer
Administrative Assistant for School Nutrition
715-243-1676
nhafemeyer@newrichmond.k12.wi.us

THIS FORM IS TO SIGN UP FOR LUNCH MEALS IN JUNE ONLY.
*Sign up for July and August is a seperate form on the district website. Click here: https://www.newrichmond.k12.wi.us/families/summer-meals.cfm
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Parent/Guardian Email: *
Parent/Guardian Cell Phone (for reminder text messages):
CHILD last name (remember: submit one form for each child) *
CHILD first name (remember: submit one form for each child) *
My child is 18 years old or younger: *
If applicable, please note any medically-documented food allergies, pre-approved by the school district.
In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:mail:
U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, D.C. 20250-9410; or fax:
(833) 256-1665 or (202) 690-7442; or email:
Program.Intake@usda.gov

 This institution is an equal opportunity provider.
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