Sack Lunch Form_OM_

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					                                                      SACK LUNCH ORDER FORM
                                            Please Order 14 Working Days In Advance of Pick-Up

                       School:                                           Teacher:
                        # Student Lunches:                                    # Adult Lunches:
                              Date Needed:                                        Time Needed:
                             Class Room #:

                                               Teacher's Signature:

Do any students have life threatening allergies:                         Yes                     No

         Student Name                                          Allergy                           Substitution Needed
                                                                                                 Yes                    No
                                                                                                 Yes                    No
                                                                                                 Yes                    No

          SANDWICH                              FRUIT                          DESSERT                    VEGETABLES
           Choose 1                            Choose 1                                                     Choose 1

Cheese Sandwich                                     Apple                                                     Carrots

Turkey Deli Sandwich                            Orange                     Marshmallow Treat                  Celery
Turkey (No Cheese)

Ham & Cheese Sandwich                           Banana
Ham (No Cheese)

Milk, 1% Regular
                                     Number Requesting
Milk, Non-Fat Chocolate
                                     Number Requesting

Lay's Potato Chips 1/2 oz Bag are included in all sack lunches.

Would you like to use an insulated collapsible cooler for hot or cold items?                     Yes                    No
Please ensure cooler is retured in good condition. We may bill for damaged coolers.

Sack lunches will be available at site kitchen (including transport site) at the time needed unless other pick-up arrangements
have been made.
                   If lunches are taken from school grounds, they must be kept at proper temperature.
                                             (See kitchen manager for details.)
                                          Use insulated coolers or boxes with ice.

                               Original - Kitchen           Copy - School Office     Copy - Teacher

      Form 19-0013 Rev. 7/06   Web Form 19-0013W

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