Form 086 - Sample Meal Count Forms (PDF) - New Mexico Kids

Organizations name:MEAL COUNT FORMChild and Adult Care Food ProgramCenter Name: WEEK 1Teacher:Week of:Room # / AM or PM:Child's NameMonday Tuesday Wednesday ThursdayFriday WeeklyLast First B AS L PS S LS B AS L PS S LS B AS L PS S LS B AS L PS S LS B AS L PS S LS Totals1 Breakfast234567 AM Snack8910111213 Lunch141516171819 PM Snack202122232425262728293031323334353637Daily TotalsNote: Although approval is granted for six (6) meals, be aware that only three (3) meals per child per day may be claimed for reimbursement. Consisting of two (2) mainmeals and one (1) snack, or two (2) snacks and one (1) main mealto

MEAL COUNT FORM Week of: / / To / / .Child and Adult Care Food ProgramCENTER NAME:Name of ChildTeacher:Class Room:MON TUE WED THU FRIB AS L PS S B AS L PS S B AS L PS S B AS L PS S B AS L PS S breakfast123 AM Snack4567 LUNCH891011 PM Snack12131415 Supper16171819 TOTAL20TOTAL