Summer Breakfast/Lunch Form

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Summer Breakfast/Lunch Form

Richland County Families:

RCCU #1 is offering 'grab and go' breakfast and lunch for ALL children ages 18 and under Monday-Thursday from June 1-June 30. All meals should be picked up in the front circle drive of Richland County Middle School between 10:30-11:30 a.m. Please note there will be NO DELIVERIES. In order to better help us plan, we are asking that families who are interested in picking up meals fill out this form.

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* Indicates required question

Parent/Guardian Name and Contact Number *

Your answer

Number of children age 18 and under to receive meals *

1

2

3

4

5

Other:

Please list any food allergy along with the child's name below.

Your answer

Submit

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