Summer Meal Pick-up June 2021

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Carry out meals available for children ages 1-18 for the month of June 2021

Carry out meals will be available for pick up each Monday in the month of June at Moberly High School and must be pre-ordered.
• Meals can be picked up at Moberly High School for any child ages 1-18.
• Meals must be pre-ordered for each week.
• To pre-order meals complete the survey form on our website. If you are unable to submit your order online, you may call the school secretary to place your order.
• Meals can be picked up each Monday between the hours of 11:00 am – 12:00 pm at Moberly High School.
o Drive through line at High School: Enter the main drive and drive toward the kitchen door on the North side of the building, just East of the Weight Room door.
• One breakfast and one lunch will be provided for each day of the week.

Name of person picking up the meals: *

Phone number of person picking up meals:

For Monday, June 7 how many children are you picking up meals for? *

For Monday, June 14 how many children are you picking up meals for? *

For Monday, June 21 how many children are you picking up meals for? *

For Monday, June 28 how many children are you picking up meals for? *

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW, Washington, D.C. 20250-9410;(2) fax: (202) 690-7442; or(3) email: program.intake@usda.gov.This institution is an equal opportunity provider.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Moberly School District #81. Report Abuse

Forms