Meal Participation Agreement Form

Free and Reduced Meals is your privilege.
Please ask your child to use it!

Please fill out one registration form per child.

Student's First Name

Student's Last Name

Names of Siblings in the School

Parent 1 First Name

Parent 1 Last Name

Parent 1 Email

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Policies & Procedures

I have read the Archimedean Breakfast & Lunch Program Policies and Procedures and I would like my child/children to participate in the following:

Breakfast Program

YES (Charge of $3.85 Paid, $0.30 Reduced, $0.0 Free) NO (Student is not permitted to receive school meal at all. On emergencies only milk & Cereal will be served)

Lunch Program

Full Time Lunch Program (Charge per meal of $6.45 for Paid, $0.40 Reduced, $0.0 Free) Half Time Lunch Program (Up to 10 meals Charge per meal of $6.45 for Paid, $0.40 Reduced, $0.00 Free) Pizza 5 Meal Lunch Program (Charge per meal of $6.45 for Paid, $0.40 Reduced, $0.0 Free) Home Lunch Program (Permits use of School lunch occasionally) No School Lunch (Student is not permitted to receive school meal at all. On emergencies only milk & Cereal will be served)

Parent Guardian Signature

Date

Please fill out one registration form per child​.

Please fill out one registration form per child.