FAMILY NAME: ___________________________
2016-17 SCHOOL MILK PROGRAM
Cost Per Carton of Milk Ordered: $15.00 per school year
$15.00 for the school year is expected to cover one carton of milk served with lunch each day.
If your child wants more than one milk with lunch, please order accordingly.
If the cost of milk service is more than projected for the school year,
we may need to collect an additional amount.
Student’s First
Name
Number of
Skim
Chocolate
Milks Per
Grade Day
Number of
1% White
Milks Per
Day
Number of
Skim White
Milks Per
Day
No Milk
Order for
this
Student
Family Total of Lunch Milks Ordered Per Day: _____________
X
TOTAL CHECK AMOUNT, PAYABLE
TO “ST. MARY’S SCHOOL MILK ACCOUNT”
(one check per family is fine)
$15.00
$________