SCHOOL LUNCH ORDER FORM

Use this form for weekly or monthly payments for all your children. Order carefully, taking into account field trips, etc. for the month. Credits will not be given for a missed lunch. Write the first name of the student(s) in the box indicating choice of lunch, lunch milk only or snack milk for each day. If you have more than one child, please write each child’s name in the box.

1. Add the number of days for each child and multiply the total by the lunch rate listed below.

2. Add the amounts in the last column to find the total for the week. Add weekly totals for monthly total.

3. Checks should be made payable to Plainfield School.

Free Lunch = -0- Full Price Lunch = $2.50 Reduced Lunch = $.40 Adult/Guest Lunch = $2.50

Week of _____________________________ Last Name ________________________________ Class _______________________________________ter School Program will be Wednesday, June 16. sters. Todate, over 35,000 volunteer pilots and a__

	Mon	Tues	Wed	Thurs	Fri	# of Lunches	@ Rate	Amount
Lunch w/ 1 milk
Lunch Milk only							.30
Snack Milk							.30
WEEK TOTAL

Week of _____________________________Last Name ________________________________ Class _____________

	Mon	Tues	Wed	Thurs	Fri	# of Lunches	@ Rate	Amount
Lunch w/ 1 milk
Lunch Milk only							.30
Snack Milk							.30
WEEK TOTAL

Week of _____________________________Last Name ________________________________ Class _____________

	Mon	Tues	Wed	Thurs	Fri	# of Lunches	@ Rate	Amount
Lunch w/ 1 milk
Lunch Milk only							.30
Snack Milk							.30
WEEK TOTAL

Week of _____________________________ Last Name ________________________________ Class _____________

	Mon	Tues	Wed	Thurs	Fri	# of Lunches	@ Rate	Amount
Lunch w/ 1 milk
Lunch Milk only							.30
Snack Milk							.30
WEEK TOTAL

Week of _____________________________ Last Name ________________________________ Class _____________

	Mon	Tues	Wed	Thurs	Fri	# of Lunches	@ Rate	Amount
Lunch w/ 1 milk
Lunch Milk only							.30
Snack Milk							.30
WEEK TOTAL

TOTAL FOR MONTH __________________________________