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1. Breakfast for<br />
Lunch<br />
French Toast<br />
Sticks w/Syrup &<br />
Pork Sausage<br />
OR Pizzeria Pizza<br />
at #4 Mary J.<br />
Donohue<br />
2. Smucker’s PB&J<br />
w/a Cheese Stick<br />
3. Bologna & Cheese<br />
Sandwich on<br />
Whole Wheat<br />
4. Cheese Sandwich<br />
5. Chicken Salad w/ a<br />
Whole Wheat Roll<br />
ELEMENTARY LUNCH ORDER FORM<br />
<strong>SEPTEMBER</strong> has 16 lunch serving days<br />
Monthly cost at $2.00 daily = $32.00<br />
Reduced lunches at $.40 daily = $6.40<br />
Free lunches = N/C<br />
Additional slice <strong>of</strong> vendor pizza = $1.75<br />
Menu Subject to Change<br />
Bread Basket, Fruit & Baby Carrots are available daily<br />
Choice <strong>of</strong> Milk Offered with Lunch:<br />
Skim, 1% White, & Non-Fat Chocolate or Strawberry<br />
Menus and Payments must be received by the 5 th serving day <strong>of</strong> the month to ensure choice <strong>of</strong> meals.<br />
PLEASE MAKE ALL CHECKS or MONEY ORDERS PAYABLE TO: BAYONNE BOARD OF EDUCATION<br />
Fill Out Form Below and Return with Payment.<br />
Please cut on dotted line<br />
- - - - - - - - - - - - - - - - - - - - - - - - - - -<br />
Student’s Name<br />
Grade<br />
Month <strong>of</strong><br />
Home Room #<br />
Amount Enclosed<br />
Parent/Guardian Name<br />
Parent/Guardian Signature<br />
Please write the # <strong>of</strong> your choice in the<br />
spaces provided – one choice per day<br />
If you are choosing Pizzeria Pizza on the day it is<br />
served in your school, please mark form with a V<br />
MON TUE WED THU FRI<br />
2 3 4 5 6<br />
9 10 11 12 13<br />
16 17 18 19 20<br />
23 24 25 26 27<br />
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