Ascension PS

Student Meal Request Form for Curbside Pickup

Page 1

Ascension Public Schools Child Nutrition Program Student Meal Request Form for Curbside Pick-up Thank you for continuing to choose Ascension Public Schools (APS) Child Nutrition Program as your children's source for nutritious and delicious meals. Please note the following: Meals will be charged according to the student's meal benefits status (free, reduced or full pay). You are encouraged to complete a meal benefits application online at 2020-2021 Student meal prices stated on the reverse of this form. Only one breakfast meal and/or lunch meal per enrolled student per day may be requested. Meal Distribution Sites: Meals will be distributed at one school per feeder system. Please refer to the reverse of this document for your child(ren)'s exact distribution site. Meal distribution sites are subject to change. Student second meals and extra sale items are subject to availability and menu option. A student lunch must be purchased in order to purchase extra sales, other than water. Please print legibly in black or blue ink. Parent's/Guardian's Name: Phone Number: Address: Street Address City Zip Code APS Enrolled Student's Name Student ID No. School Meal Options Extra Sales Breakfast Lunch 2nd Lunch Water Cookies Parent/Guardian: By signing below, you consent for meal pick-up, appropriate meal charge(s) to the student's account as determined by their current meal benefits status. You also consent that the meal(s) is/are solely for the student(s) listed above. Name of person picking up meals (Print) Signature of person picking up meal Signature of Parent/Guardian Date If you have any questions or require additional information, please do not hesitate to call the Child Nutrition Program office at (225) 391-7335.

Page 2

Ascension Public Schools Child Nutrition Program 2020-2021 Meal Prices Grade Level Meal Benefits Status Breakfast Meal Lunch Meal Price $.30 $1.30 Reduced 40 Primary School Students Full Pay $2.45 $.30 $1.30 $.40 $2.45 Reduced Middle School Students Full Pay Reduced $.30 $1.30 $.40 $2.70 - $2.95 Hgh School Only High School Students Pizza Meal Full Pay Student Second Meal $2.05 All Grade Levels Free/Reduced/Paying $4.10 Extra Sales Price $.75 $1.00 Item Water Cookies Meal Distribution Sites Enrolled School Meal Distribution Site Donaldsonville High Lowery Middle Donaldsonville Primary Lowery Elementary/Middle Lowery Elementary Dutchtown High Dutchtown Middle Dutchtown Primary Spanish Lake Primary Bullion Primary Prairieville Middle Prairieville Primary Oak Grove Primary Bluff Middle Dutchtown High Bluff Ridge Primary East Ascension High Gonzales Middle Pecan Grove Primary Central Middle Central Primary Duplessis Primary East Ascension Gonzales Primary G.W. Carver Primary St. Amant High St. Amant Middle St. Amant Primary Galvez Middle Galvez Primary Lakeside Primary St. Amant High or Sorrento Primary Lake Elementary Early College Option & APPL Students Home School Feeder System's Distribution Site(s) This institution is an equal opportunity provider.

Flyer ID 1012169

Sent from Ascension PS

© 2019 Peachjar. All rights reserved.