School Copy

Student Name: Grade: Week Of:

	Monday	Tuesday	Wednesday	Thursday	Friday	Total
MILK Only $.50
Lunch W/Milk $2.75 K-4
Lunch W/Milk $3.00 5-8
Reduce Lunch W/Milk $.50
Free Lunch W/Milk $.00

Please write down your main meal choice. Separate payments for each child if you have more than one child. Total Due:

Attach a check made payable to St. Margaret Regional Lunch Program or an envelope with exact cash to this form. Child's name must

be on the check or envelope. Return by 8:00 on due date.

Home Copy

Student Name: Grade: Week Of:

	Monday	Tuesday	Wednesday	Thursday	Friday	Total
MILK Only $.50
Lunch W/Milk $2.75 K-4
Lunch W/Milk $3.00 5-8
Reduce Lunch W/Milk $.50
Free Lunch W/Milk $.00

Please write down your main meal choice. Separate payments for each child if you have more than one child. Total Due:

Attach a check made payable to St. Margaret Regional Lunch Program or an envelope with exact cash to this form. Child's name must

be on the check or envelope. Return by 8:00 on due date.