At Home Breakfast/Lunch Program
**Please complete this form for the month of DECEMBER**

Students enrolled at the Saginaw Chippewa Academy will have the opportunity to receive a school breakfast and lunch delivered to them on days they learn from home. This will now be extended to ALL CHILDREN IN HOUSEHOLD (ages 0-18). Meals will be delivered between 11am-12pm (actual times may vary). Please be sure to be on the lookout, as someone will need to be home to accept the delivery. Additional children in household will still receive delivered meals on days SCA enrolled student attends face-to-face.

If you choose this service, you will receive meals for the month of DECEMBER, and will have to complete a new form to receive meals for each consecutive month. This is to make sure we are ordering and preparing enough food on a regular basis.

At this time, we are able to provide all students with FREE breakfast and lunch. This may change at some point in the school year, as we are receiving federal funding that may not be available in the near future. Please note that once federal funding for free lunch is no longer available, students will be charged the regular price for lunch, but breakfast will still remain free. If you need to put money on your student's lunch account, you can bring in cash or a money order to the front desk.

If you would like your child(ren) to receive a school breakfast and lunch on days they are learning at home, please complete this form. If you have any questions, please feel free to contact the SCA office at 989-775-4453.
SCA Student Name *
How many children in the household would you like lunches delivered to? *
Parent/Guardian Name *
Home Address
Where meals will be delivered
Street Number/Name *
City *
Phone number *
Yes, I want my child to receive a breakfast and lunch on days he/she learns at home. *
Required
I understand that I will be charged for all lunches that are delivered (if/when meals are no longer free of charge) . Meals will be charged to the student's school lunch account. *
Required
Would you like to receive a free/reduced lunch application?
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