COVID-19 Breese District 12 School Lunch Program
We will be providing lunches for K-8 students when students are engaged in remote learning.

Please note: This form is timestamped. Form MUST BE SUBMITTED BY 11:59PM the night before to ensure we have enough product to fulfill lunch orders.

Lunches are provided for K-8 Students enrolled at Breese District 12. Breese District 12 student accounts will be charged accordingly for lunches that are provided. Free Lunches will be provided for families who qualify. All lunches will need to be picked up at the designated time and place below.

- Lunches will follow State Nutritional Guidelines and comprised of what is available for distribution at that particular time. We will have a menu posted weekly, but will not fulfill particular food requests unless there is a food allergy that can be described below.

-Pick up window will be everyday at your requested location from 11:30 am to 12:30 pm.

ALL REQUIRED INFORMATION MUST BE COMPLETED BELOW TO RECEIVE A LUNCH
Lunch Choice *
Email address *
Phone #: *
Please provide a contact number should we need to get in contact with you.
Name of Children being Served (Last, First) *
Include multiple students by hitting return after each student entered
Total Number of Student Lunches being requested? *
Are there any food allergies for the Students listed above?
If yes, please list the name and food allergy next to the students name below.
Pick Up Location *
Submit
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