ACPS Breakfast/Lunch Delivery Form
ACPS employees will be delivering (2) breakfasts and (2) lunches on Tuesdays and Thursdays for children ages 18 and under, regardless of income or financial need. The menu for each delivery day is listed below:

Tuesday, March 31st:
Breakfast #1: Wholegrain muffin, fruit juice, milk
Breakfast #2: Pancakes, fruit juice, milk
Lunch #1: Ham and cheese sandwich on wholegrain bun, fresh fruit, baby carrots, milk
Lunch #2: Uncrustable sandwich with cheese stick, fresh fruit, baby carrots, milk

Thursday, April 2nd:
Breakfast #1: Assorted cereal, fruit juice, milk
Breakfast #2: Waffles, fruit juice, milk
Lunch #1: Cold pork barbeque sandwich, apple slices, baby carrots, milk
Lunch #2: Turkey and cheese sandwich on wholegrain bun, fresh fruit, fresh vegetable, milk

Please have all meal orders in for the week no later than Sunday, March 29, 2020 at 3:00 P.M., which will allow us to adequately plan and prepare an accurate number of meals for delivery.

*As a reminder, ACPS will not deliver student meals during the week of Spring Break: April 6-14, 2020. After Spring Break we will resume meal deliveries on Thursday, April 16, 2020.
Delivery Address for Food; please include exact address, including city and zip code (* meals can only be delivered to addresses in Amelia County) *
Your answer
Name of Adult Requesting Meal Delivery *
Your answer
Best contact number of Adult Requesting Meal Delivery *
Your answer
Number of children 18 and under requesting meals to be delivered at this address. *
I am requesting meals to be delivered on the following dates *
Required
Any food allergies or special dietary restrictions noted?
Your answer
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