School Meal Request form for Virtual Students (2020)
Parents of students participating in Virtual Learning for the first semester of 2020, have the opportunity to pick up breakfast and lunch meals for their students. Meal pick-up will be Tuesdays through Fridays from 1:30 to 2:30 at Covington Elementary, door #3. One breakfast meal and one lunch meal will be given each day. All students, regardless of home school will pick up their meals at Covington Elementary.
Breakfast will contain a cereal bowl, cracker, whole fruit and a carton of milk. Lunch will contain a cold meat sandwich, whole fruit, vegetable and a carton of milk. Ingredients subject to change based on availability.
The cost of breakfast is $1.65 full-pay, $0.30 reduced and free by status. The cost of lunch is $3.10 full-pay, $0.40 reduced and free by status. Families are encouraged to complete the Free and Reduced Meal Application. Some students may qualify for free or reduced price meals.
Parents wanting to pick-up meals for their students participating in virtual learning should complete this form. Meals will be prepared on the days requested. If a parent requests to pick up meals, and fails to pick them up three times in a row, the kitchen will no longer prepare meals per the request. Another request form must be submitted to resume service.
For questions, please contact Mike Penne, Food Service Director at 402-375-8717 or
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number
Student First Name
Student Last Name
Student Lunch ID/PIN Number
Student's School (Meal pick-up is at Covington Elementary regardless of regular attendance center)
South Sioux City High School
South Sioux City Middle School
E.N. Swett Elementary
Lewis & Clark Elementary
Dakota City Elementary
Enter the date you wish to begin picking up meals
Please indicate what meals you want to pick up
Please indicate what days you will pick up meals
If you have other students in your family participating in virtual learning who you would like to pick up meals for, please list below their First Name, Last Name, Lunch ID/PIN Number, School and Grade
Other comments or questions
Never submit passwords through Google Forms.
This form was created inside of South Sioux City Schools.