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					                                                        South Carolina Department of Social Services
                                                        Child and Adult Care Food Program (CACFP)
                                                             WEEKLY MENU FORM

Provider’s Name:____________________________________________________________________________ Month/Year: ______________________

                                             Monday     Tuesday       Wednesday        Thursday        Friday   Saturday   Sunday
                  Calendar Date
               Fluid Milk
Breakfast




            Fruit, Vegetable or Full
            Strength Juice
            Bread or Bread Alternate(s)

            *Additional Food (Optional)
            Choose 2 of these 4:
            Fluid Milk
AM Snack




            Fruit, Vegetable or Full
            Strength Juice
            Bread or Bread Alternate
            Meat or Meat Alternate
            Fluid Milk
            Meat or Meat Alternate
            Vegetable or Fruit
Lunch




            Vegetable or Fruit
            Bread or Bread Alternate(s)
            *Additional Food (Optional)
            Choose 2 of these 4:
            Fluid Milk
            Fruit, Vegetable or Full
PM Snack




            Strength Juice
            Bread or Bread Alternate

            Meat or Meat Alternate
 DSS Form 1674 (SEP 98) Edition of OCT 91 is obsolete
                                                            South Carolina Department of Social Services
                                                           Child and Adult Care Food Program (CACFP)
                                                                WEEKLY MENU FORM

Provider’s Name:____________________________________________________________________________ Month/Year: ______________________

                                               Monday     Tuesday       Wednesday         Thursday         Friday   Saturday   Sunday
                    Calendar Date
                Choose 2 of these 4:
                Fluid Milk
PM Snack




                Fruit, Vegetable or Full
                Strength Juice
                Bread or Bread Alternate
                Meat or Meat Alternate
                Fluid Milk
                Meat or meat Alternate
Supper




                Vegetable or Fruit
                Vegetable or Fruit
                Bread or Bread Alternate (s)
                *Additional Food (Optional)
                Choose 2 of these 4:
                Fluid Milk
Evening Snack




                Fruit, Vegetable or Full
                Strength Juice

                Bread or Bread Alternate

                Meat or Meat Alternate
 DSS Form 1674-1 (SEP 98) Edition of OCT 91 is obsolete

				
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