ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Rio Food Service Permission Slip 2025/2026
2
3
My elementary student(s) (grades 4k-5th) may purchase:
4
Student Name (First and Last Name)
Grade*Milk Only-
No
breakfast
5
6
7
8
9
*Parents only check what you allow
10
11
My middle/high school student(s) (grades 6th-12th) may purchase:
12
Student Name (First and Last Name)
Grade FREE Breakfast allowed *Milk Only-
No
breakfast		Lunch
allowed 		*Extra lunch entree
13
14
15
16
17
*Parents only check what you allow
18
19
High School Students ONLY (Grades 9th-12th) ALA CARTE ITEMS
20
Student Name (First and Last Name)
Grade *YES
allow purchases 		*NO
Do NOT allow
purchases
21
22
23
24
*Parents only check what you allow
25
26
* Extra Lunch Entree: This option allows your child to choose a second entree for an additional cost of $2.00 This cost is not covered by free or reduced eligibility

* Milk only - No Breakfast: This option allows your child to only have milk at breakfast for a cost of $.50. This cost is not covered by free or reduced eligibility
27
*A la Carte: This is only available to 9th-12th graders.
Items included but not limited to: chips, fruit snacks, candy bar, rice krispie treat, fruit, assorted beverages, cookies, brownies, hot items(pizza, grilled cheese, bosco sticks, etc). Prices range from $.50 - $3.50. Items will be deducted from the food service account.
28
Lunch accounts are NOT to fall below $0 - no super meals/a la carte will be allowed if balance is negative
29
30
Sign (Parent/Guardian)___________________________________ Date_______________
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100