January & February Hot Lunch Form
Fill out one form for each student.
Price for each meal is $2.50 for the first item and $.25 for an extra serving.

Wed., Jan. 10th - Cheesy Bread sticks w/marinara, Salad, Steamed Carrots, Fruit
Fri., Jan 12th - Spaghetti w/Meatballs, Texas toast, Mixed Veggies, Fruit
Wed., Jan 17th - Tacos (Beef or Chicken) Corn, Fruit
Fri., Jan 19th - Oven fried Chicken, Twice baked potato, Broccoli, Fruit
Wed., Jan 24th - Tater tot Casserole, Green Beans, Fruit
Fri., Jan 26th - Homemade Chicken Noodle Soup, Grilled Cheese, Fresh Veggies w/dip, Fruit
Wed., Jan 31st - Hot Dog/Chili Dog, French Fries, Cali blend Veggies, Fruit

Fri., Feb. 2nd - Chicken Parmesan over Pasta, Peas & Carrots, Fruit
Wed., Feb 7th - Pizza (Cheese or Pepperoni) Broccoli/Cauliflower, Fruit
Fri., Feb. 9th - Special Person's Day - Arby's, Cheesy Potatoes, Salads, Pickles, Dessert
Wed., Feb. 14th - Pancakes, Bacon or Sausage, Hash Browns, Mandarin Oranges
Fri., Feb. 16th - Chicken Patty w/bun, Pickles, Tater Tots, Salad, Fruit
Wed., Feb. 21st - Chicken Burrito Bowls (w/rice & taco fixins) Tortilla chips, fruit
Fri., Feb. 23rd - Meatball Subs, Chips, Pickles, Coleslaw, Fruit
Wed., Feb. 28th - Bacon Burgers, Mac n' Cheese, Green Beans, Fruit

First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Grade Level *
Order *
Select 1 answer per row!
1 + Extras
Bread Sticks w/Marinara
Spaghetti w/Meatballs
Tacos (Beef or Chicken)
Fried Chicken
Tater Tot Caserole
Chix Soup & Grilled Cheese
Hot Dogs
Chix Parmesan w/pasta
Pizza (Cheese or Pepperoni)
Special Persons Day - Arby's
Chix Patty w/bun
Chix Burrito Bowl
Meatball Subs
Bacon Burgers
Special Person's Day (2/9) Please enter the name(s) of your guests!! Adults @$3.50 ~ Additional Children @$2.50 ~ Toddlers @ Free. If you do not know who will be attending, an additional guest sign up will be available mid January! *
Your answer
If you ordered Pancakes (Wed., 2/14) would you like bacon or sausage? *
Total Cost (Enter as number without $ symbol) *
Please add up your total. (Each 1 = $2.50; 1 + Extras = $2.75)
Your answer
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