JANUARY HOT LUNCH ORDER FORM
Complete one form for each student. Name and Grade must be complete to process!
Circle one meal per day. PRINT CLEARLY!
STUDENT NAME:
STUDENT GRADE: KA KB 1A 1B 2A 2B 3A 3B 4A 4B 4C
MIDDLE SCHOOL 1st PERIOD TEACHER:
5A
5B
6
7
8
MONDAY 1/4
TUESDAY 1/5
WEDNESDAY 1/6
THURSDAY 1/7
NO SCHOOL
cheese pizza
pepperoni pizza
chicken burrito
cheese quesadilla
mac & cheese
MONDAY 1/11
CHICKFILA
chicken sandwich
chicken nuggets
TUESDAY 1/12
WEDNESDAY 1/13
THURSDAY 1/14
cheese pizza
pepperoni pizza
hot dog
Italian sausage
cheese steak
MONDAY 1/18
TUESDAY 1/19
WEDNESDAY 1/20
THURSDAY 1/21
NO SCHOOL
cheese pizza
pepperoni pizza
Mac & cheese
Turkey Sub
Ham Sub
MONDAY 1/25
TUESDAY 1/26
WEDNESDAY 1/27
THURSDAY 1/28
chicken fingers
cheese pizza
pepperoni pizza
Chicken quesadilla
cheese steak sub
hot dog
GRADES K-2 $3.75 X # of meals_________________ Total $____________________
GRADES 3-8 $4.50 X # of meals__________________ Total $____________________
Extra slice of pizza $1.00 (limit one slice per pizza day) $___________________
Lunches are served with a side and dessert. Grand Total$____________________
Please make check payable to SRCS and return to the school office by December 16th AT 4:00 PM
FORMS WILL NOT BE ACCEPTED AFTER THIS DATE!
Please copy for your records! Take a photo with your phone so you will always know when you ordered!