KINGSVIEW VILLAGE JUNIOR SCHOOL MID-MORNING MEAL

Snack Registration Form

Name of Child: _______________________________________________

Name of Teacher:____________________ Grade: ______ Room: ______

I agree to let my child take part in the Mid-Morning Meal.

Yes: ______     No: ______

Parent Signature:_______________________________________

Does your child have any food allergies, conditions or restrictions?

Yes: ______     No: ______

If Yes, list any allergies/conditions or restrictions your child may have:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____ I have enclosed $5.00 (I would like to pay by month)

____ I have enclosed $45.00 (I would like to pay for the entire year)

The program will begin Monday September 17, 2018