PLEASE DO NOT FILL OUT THIS FORM!

The deadline for ordering hot lunches has passed.

Thank you for your understanding!

Pizza and Chicken Order Form

To order your lunch service online, please complete this form and then proceed to our online store for payment. We will provide a payment link and additional instructions on the order confirmation page. If you order online, you must pay online. Orders are not considered complete until the online payment is received.

 
Parent's Full Name:  
 

Pizza:
Child's Name
# of PLAIN Slices
# of Pepperoni Slices
Check if Not Participating
Teacher Name Grade
Subtotals by slice:      
Total Pizza cost per week:
 
Total Pizza cost for the term (weekly cost X weeks)
 

Chick-Fil-A®:
Child's Name
# of
8-peice CHICKEN Nugget boxes

# of CHICKEN Sandwiches
Check if Not Participating
Teacher Name Grade
Subtotal by Item:
         
Weekly Chicken Cost:  
 
Total Chicken cost for term (weekly cost X weeks):
 

Total cost of order:  

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WILLING TO HELP SERVE (you will be contacted by phone on specific dates).
Phone:
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911 Generals Hwy, Millersville, MD 21108 - P: 410-923-1171 - learning@rockbridge.org