Schoolwide Provided Snacks & RICAS Snack Permission Form

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RICAS testing will be starting soon for students in Grade 3, 4 & 5, students are encouraged to bring an extra "non-messy, non-noisy" snack from home, as well as a water bottle. We will also be providing a snack for those students that don't bring something from home. Choices will be a package of Pirate's Booty White Cheddar Puffs, LifeSavers (mint or assorted fruit flavors) or Trident gum for them to choose from, along with a small water if they forget their own water bottle. Students can also bring (from home) sugar free, non-bubble gum to chew quietly.

Students may not share snacks/gum with one another!

See Ingredients Lists Below!

**THIS FORM MUST ONLY BE COMPLETED IF YOU WOULD PREFER YOUR CHILD NOT HAVE A SNACK, POPSICLE or KONA ICE**

In addition there are times during the warmer months that we have popsicles available for students and/or Kona Ice comes to the school. Please fill out this form only if you prefer your child NOT receive a popsicle or Kona Ice.

Email *

I DO NOT GIVE PERMISSION for my son/daughter to have the following (ingredients below)

check all that apply *

No, my son/daughter CANNOT have any extra snack; they will be bringing in their own snack and water.

My son/daughter may only have Pirate's Booty White Cheddar Puffs

My son/daughter may only have LifeSavers

No - My son/daughter cannot have Fla-Vor-Ice popsicle (I will send in a special snack)

No - My son/daughter cannot have KONA Ice (I will send in a special snack)

Required

Student First Name *

Student Last Name *

Grade *

Grade K

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Teacher *

Miss Filbert

Mrs. Henriksen

Mrs. Lakeway

Ms. Staruch

Mrs. Adler

Mrs. David

Mrs. Martinelli

Mrs. Patnaude

Miss Aceto

Mrs. Castellanos

Miss Kibbe

Mrs. Pushee

Mrs. Bearss

Mrs. Ferreira

Ms. Tanski

Miss Reddy

Miss Alteiri

Ms. Arndt

Mrs. Grace

Mrs. LaChapelle

Mrs. Beaudette

Mr. Firth

Mrs. Paiva

Miss Pirri

INGREDIENTS LISTING: WHOLE CORN MASH FLOUR, ENRICHED
CORNMEAL (CORNMEAL, NIACINAMIDE (VITAMIN B3), FERRIC
PYROPHOSPHATE (IRON), THIAMIN HYDROCHLORIDE (VITAMIN B1),
RIBOFLAVIN (VITAMIN B2), FOLIC ACID), SUNFLOWER OIL AND/OR
EXPELLER PRESSED CANOLA OIL, ENRICHED RICE FLOUR (RICE FLOUR,
NIACINAMIDE (VITAMIN B3), FERRIC PYROPHOSPHATE (IRON),
THIAMIN HYDROCHLORIDE (VITAMIN B1), RIBOFLAVIN (VITAMIN B2),
FOLIC ACID), CHEDDAR CHEESE (CULTURED MILK, SALT, ENZYMES),
WHEY, BUTTERMILK, SALT, SEA SALT, CITRIC ACID, ORGANIC BLACK
PEPPER.
ALLERGENS:CONTAINS MILK
Made in a Peanut and Tree Nut Free facility
Gluten Free

Life Savers - Mint
Ingredients: Sugar, Corn Syrup, Artificial Flavor, Stearic Acid.

Life Savers - Hard Candy - 5 Flavors

Ingredients: Sugar, Corn Syrup & High Fructose Corn Syrup, Citric Acid, Natural and Artificial Flavors, Colors (Red 40, Yellow 5, Blue 1).

Trident - Original Flavor - Gum

Ingredients: Sorbitol, Gum Base, Xylitol, Glycerin, Natural and Artificial Flavor; Less than 2% of: Acesulfame Potassium, Aspartame, BHT (to Maintain Freshness), Mannitol, Soy Lecithin, Sucralose.

Fla-Vor-Ice Freeze Pop (ingredients below)

KONA Ice (ingredients below)

A copy of your responses will be emailed to the address you provided.

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