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Request for Meal Account Restrictions

To improve our service efficiency and accuracy, we will update the notes portion of your student's meal account. If you would like to place any purchase restrictions on your student's account, please choose from the following options.

You are not required to return this form; however, the absence of notes on your student's account will indicate no restrictions on your child's account, and they will be allowed to purchase what they choose.

*Please complete one form for EACH child (each school year).

Student Name *

Grade Level *

Breakfast *

Lunch *

A La Carte/Extra Portions *

Second Complete Meal *

Snacks *

Ice Cream *

If you would like your child to purchase snacks or ice cream only once per week, please indicate notes here. *

Parent Signature

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Today's Date *