Please Order Breakfast for My Child As Follows

December Meal Order December 4 thru January 5, 2018

Child’s name: ______

BREAKFAST

Please order breakfast for my child as follows:

___ ALL days from March 19-April 27 (25 breakfasts x $0.30) = $7.50

-or-

___ breakfast on the following days (please circle each day you wish to order breakfast)

March 19 20 21 22 23 26 27 28 29 30 April 2 3 4 5 6 9 10 11 12 13 23 24 25 26 27

# of days circled x $0.30 = $______

LUNCH

Please order lunch for my child as follows:

___ ALL days from March 19-April 27(25 lunches [no milk] x $0.40 = $10.00)

-or-

___ ALL days from March 19-April 27(25 lunches [WITH milk] x $0.85 = $21.25)

-or-

___ Lunch on the following days (please circle each day you wish to order lunch)

March 19 20 21 22 23 26 27 28 29 30 April 2 3 4 5 6 9 10 11 12 13 23 24 25 26 27

# of days circled x $0.40 = $______(NO Milk) -or-

# of days circled x $0.85 = $______(WITH Milk)

This form must be returned to MPA by March 12, 2018. Thank you!

PLEASE DO NOT PAY IN ADVANCE. MPA will send a monthly invoice home, net payment 30 days. Please make checks out to “Family Service of RI”, and in the Memo section, write “MPA Meals”. Because meals are ordered and purchased ahead of time, we cannot issue refunds if a child is absent. Scheduled absences (e.g., family vacation) must be communicated to MPA at least one week prior to the start of the absence to avoid being charged. Accounts that are unpaid after 90 days will be sent to Collection and the student’s participation in the MPA Meal Plan may be suspended. Gluten-Free and Dairy-Free options are available with advanced notice and medical order.

______

Parent/Guardian SignatureDate

REDUCED PRICE