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South Carolina Department of Social Services
Weeks 1, 2 and 3
Child and Adult Care Food Program (CACFP)
WEEKLY MENU FORM
SAMPLE
Provider’s Name: CINDY’S AFTERSCHOOL PROGRAM Month/Year: FEB 2001
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Calender Date 2/1 2/2
Choose 2 of these 4: Milk (8oz.)
Fluid Milk
Fruit, Vegetable or Graham Saltines (8)
Crackers (8)
PM Snack
Full Strength Juice
String Cheese
Bread or Bread Alternate (1)
Meat or Meat Alternate
Total Number of Children Served 17 19
Calender Date 2/5 2/6 2/7 2/8 2/9
Milk (8 oz)
Choose 2 of these 4:
Fluid Milk
Fruit, Vegetable or Cherry Applesauce Tomato
Full Strength Juice Juice (6oz) (3/4 cp) Juice (6oz)
PM Snack
Cheese Poptart Animal Corn Chips Honey Comb
Bread or Bread Alternate Crackers (1) Crackers (7) Cereal
(20) (14) (3/4 cp)
Meat or Meat Alternate Peanuts(1oz)
Total Number of Children Served 24 21 16 20 21
Calender Date 2/12 2/13 2/14 2/15 2/16
Choose 2 of these 4:
Fluid Milk
Fruit, Vegetable or
Apple Juice Banana (1) Apple (1)
Full Strength Juice
PM Snack
Pretzels RitzCracker (6oz)
Bread or Bread Alternate (16) (7) Graham
String Peanut Crackers (8)
Meat or Meat Alternate Cheese (1) Butter(2tbls) Yogurt (4oz) Peanut
Butter (2tbls)
Total Number of Children Served 27 22 17 19 20
DSS Form 1674-2 (Sep 99)
SAMPLE
Week 4 and 5
Provider’s Name: CINDY’S AFTERSCHOOL PROGRAM Month/Year: FEB 2001
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY
Calender Date 2/19 2/20 2/21 2/22 2/23
Choose 2 of these 4: Milk (8oz)
Fluid Milk
Fruit, Vegetable or Orange (2) Grape Juice Banana (1)
HOLIDAY (6oz)
PM Snack
Full Strength Juice
Ginger Pretzels Choc. Chip Gold-N-Cheese
Bread or Bread Alternate Snaps (7) (16) Cookies (6) (1 pk.)
Meat or Meat Alternate
Total Number of Children Served 0 16 21 23 17
Calender Date 2/26 2/27 2/28
Choose 2 of these 4: Milk (8oz)
Fluid Milk
Fruit, Vegetable or Fruit Apple Juice
Full Strength Juice Cocktail (6 oz.)
PM Snack
(3/4 cp) Graham Vanilla
Bread or Bread Alternate Crackers (8) Wafers (8)
Yogurt (4oz)
Meat or Meat Alternate
Total Number of Children Served 22 16 23
TOTAL FOR THE MONTH: 381
DSS Form 1674-2 (Sep 99) Page 2
