USC Meal Order for Pick-Up for Nov. 30-Dec.4
Complete this form BY 8 AM MONDAY, NOVEMBER 30th if you want meals delivered to a fire station for your children on these days: November 30--December 4

- COMPLETE A SEPARATE FORM FOR EACH CHILD. (Note: You do not need to order meals for students in the daycare program.)

- PICK UP LOCATIONS:Fire Stations in Bricelyn, Easton, Freeborn, Kiester, Walters, and Wells

- Meals will be available for pick-up between 11:00-11:30.

* USDA has extended the FREE meals wavier to continue for all children enrolled in our district throughout the 2020-21 school year. USC will provide free meals to all students in our district.
First Name of Person Completing this Form *
Last Name of Person Completing this Form *
Student's First Name (Reminder: Complete a separate form for each child.) *
Student's Last Name *
Grade Level of Student *
On which days do you need a meal for your student?
Mon., Nov. 30
Check if you want a meal for your student on this day.
Tues., Dec. 1
Check if you want a meal for your student on this day.
Wed., Dec. 2
Check if you want a meal for your student on this day.
Thurs., Dec. 3
Check if you want a meal for your student on this day.
Fri., Dec. 4
Check if you want a meal for your student on this day.
Meal pick-up is between 11:00-11:30 AM. From which FIRE STATION will you pick up your meals? *
Does your child have a documented doctor's order for a special diet or food allergy? *
If so, please list:
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