Orders for Week 4 are due June 27th

Please complete one form for each student. Note that we will not be issuing changes or refunds after an order is submitted.

Child's Name *

First

Last

Parent's Name *

First

Last

Parent's Email for receipt *

Mon: Panera

Meals include an apple and chips

Meals include chips and salsa

Meals include chips and a cookie

Meals include chips & cookie

Box lunches are $12.00 each day, or $50.00 for the entire week *

Lunches for the Week (make your entree selection for each day below) *

Check the box to place an order for each day, and make your entree selections below *

Monday Entree Choice *

Tuesday Entree Choice *

Wednesday Entree Choice *

Thursday Entree Choice *

Friday Entree Choice *

Order Total

$ 0.00

Stripe Credit Card *

Card

Name on Card