SMSD Meal Request Sign Up Form
If you are not currently receiving meal service from South Middleton School District and would like to request meals, please complete this sign up form.

Please be aware that meals will be available for pick up on Tuesdays and Thursdays between 10:00 AM and 11:00 AM in front of Boiling Springs High School and W.G. Rice Elementary School. You will need to identify which site you would like to pick up your meals in the sign up.

You may request meals for all the children residing in your household that are between the ages of 0-18. You will receive two breakfasts and two lunches for each child on Tuesdays and five breakfasts and five lunches for each child on Thursdays.

We will be providing meal service every Tuesday and Thursday through August 27, 2020.

>> Once you have completed the sign up on this form, you may begin picking up meals on the designated days. You will not receive any additional confirmation.<<
**By completing this form to request meals, you are committing to picking up your meals on all the designated distribution days in order to reduce waste. **
Due to supply issues, there will likely be changes in the menu options listed below.
Menu Information
Weekday Meal Items:
Sample Breakfasts will include items such as:
1. Cereal bars, pop tarts, cereal bowls, microwavable waffles or pancakes, or muffins
2. Graham crackers
3. Fresh fruit or package of dried fruit or fruit juice
4. Milk

Sample Lunches will include items such as:
1. Uncrustable sandwich; ham and cheese sandwich; turkey and cheese sandwich; chicken patty sandwich; chicken tenders/nuggets; or pizza
2. Assorted vegetables or two fruits (fresh or packaged or frozen)
3. Snack and cookie
4. Milk

Weekend Meal items:
Sample Breakfasts will include items such as:
1. Variety of muffins, yogurt, oatmeal, fruit pastry and string cheese
2. Graham crackers
3. Fresh, packaged or dried fruit
4. Milk

Sample Lunches will include items such as:
1. Stuffed bread sticks, pizza dippers, mozzarella sticks, chicken sandwich or personal sized pizza
2. Snack/chips and cookie or granola bar
3. Assorted veggies and fruits: fresh, packaged or dried
4. Water

These menu items are subject to change based on availability. We are not able to make substitutions and we are not able to accommodate gluten free requests, sorry.
Name of Parent/Guardian *
Contact phone number *
Contact email address *
Home address *
Name of Child 1 *
Grade of Child 1 *
School Child 1 attends *
Name of Child 2
Grade of Child 2
School Child 2 attends
Name of Child 3
Grade of Child 3
School Child 3 attends
Name of Child 4
Grade of Child 4
School Child 4 attends
Name of Child 5
Grade of Child 5
School Child 5 attends
Name of Child 6
Grade of Child 6
School Child 6 attends
Name of Child 7
Grade of Child 7
School Child 7 attends
Please confirm the total number of children in your household (ages 0-18) that you are requesting meals for. (Please note: we do not provide infant food or formula. See sample menus above.) *
Pick a site for Meal Pick Up *
📝 Once you have completed and submitted this sign up form, you may begin picking up your meals on the designated days. You will not receive any additional confirmation.
If you have any questions or need additional support, please contact us at
** This Institution is an equal opportunity provider. **
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