Segment V (4/5/21-last day of school) Meal Request
All meals must be pre-ordered by a legal parent/guardian. Meal pick up will be daily on days when school is in session. Parent/guardian may give permission for someone to pick up meals on their behalf, please list the name of that person below.

This form should only be submitted ONCE per segment. Submission of this form is for the entire duration of segment FIVE (4/5/21-last day of school). To modify or cancel your request, please contact the School Nutrition Department directly.

After submitting the request you should receive an email with a copy of your responses. This email serves as a confirmation of the request. Meal pick up can begin the first school day after your request has been submitted.

All meals are free of charge for any child 18 and under. If requested, breakfast and lunch will be provided at time of meal pick up.

If you have more children than spaces or have questions related to this request form, please contact the School Nutrition Department at (207) 247-3221 x2257 or email vanessarichardson@rsu57.org

**Please contact the School Nutrition Office by 9am if you are unable to pick up meals for the day.

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Email *
Menus **Please note that menus are subject to change without notice.  We will do our best to provide meals that are in line with our monthly menus per pick up site.
Parent/Guardian Full Name *
Parent/Guardian Primary Contact # *
Full Name of Person Picking Up Meals (if other than yourself)
Full Name Child #1 *
Child #1 Breakfast Request (meals are only available on student school days, refer to district calendar) *
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Breakfast
Child #1 Lunch Request (meals are only available for student school days, refer to district calendar)                               *
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Lunch
Full Name Child #2
Child #2 Breakfast Request (meals are only available for student school days, refer to district calendar)
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Breakfast
Child #2 Lunch Request (meals are only available for student school days, refer to district calendar)
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Lunch
Full Name Child #3
Child #3 Breakfast Request (meals are only available for student school days, refer to district calendar)
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Breakfast
Child #3 Lunch Request (meals are only available for student school days, refer to district calendar)
Monday
Tuesday
Wednesday
Thursday
Friday
N/A
Lunch
Daily meal pick up will be available on all school days. Please note that each site has a specific time frame for meal pick up. *
Required
Meal Pick Up Site (students enrolled school or school closest to your home) *
Required
Do any of the children have a disabling medical condition that affects their diet and requires a meal modification? Select the child this is applies to and a member of our School Nutrition team will be in contact with you. All requests for meal modifications will require documentation from a licensed medical provider. *
My children are: *
Questions & Comments
A copy of your responses will be emailed to the address you provided.
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