7/17/2019 Hot Dog & Pizza Fall 2015

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SOUTHLANDS ELEMENTARY HOT DOG AND PIZZA LUNCH PROGRAM – FALL SEMESTER 2015Please retr! "# !$ later t%a! Fr&'a#( Se)te*"er 25( 2015

Student Name: _________________________________ Grade: ________ Div.: ______________ 

Parent/Guardian Name: __________________________ Email: _________________________________

PIZZA DAYS

Small Combo = 1 slice/chocolate chip cooie/mil = !".##$ar%e Combo= & slices/chocolate chip cooie/mil = !'."#

Please select: Small Combo ________ $ar%e Combo ________  

Please select: Cheese ________ Pepperoni ________ 

Please select: Chocolate (il ________ &) (il ________ No (il: ________ 

Please indicate an* dietar* restrictions: ____________________________________________ 

Please chec da*s *ou +ould lie *our child to have a pi,,a lunch:

-ct : ________ -ct && 0hur: ________ November ': ________ Nov &#: ________

Dec 2: ________ Dec 13: ________ 4an 1": ________ 4an &: ________

S56 0-07$: 8 o9 Da*s: ________ Price o9 Combo: ________ = !___________

HOT DOG DAYS

Small Combo = 1 hot do%/chocolate chip cooie/mil = !".##$ar%e Combo= & hot do%s/chocolate chip cooie/mil = !'."#

Please select: Small Combo ________ $ar%e Combo _______ 

Please select: Chocolate (il ________ &) (il ________ No (il: ________ 

Please indicate an* dietar* restrictions: ____________________________________________ 

Please chec da*s *ou +ould lie *our child to have a hot do% lunch:

-ct 1': ________ -ct ;#: ________ Nov 1;: ________ Nov &' 0hur: ________

Dec 11: ________ 4an 3: ________ 4an &&: _______ 

S56 0-07$: 8 o9 Da*s: ________ Price o9 Combo: ________ = !___________

0-07$ 7(-5N0 D5E: __________ 

7/17/2019 Hot Dog & Pizza Fall 2015

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SOUTHLANDS ELEMENTARY HOT DOG AND PIZZA LUNCH PROGRAM – FALL SEMESTER 2015Please retr! "# !$ later t%a! Fr&'a#( Se)te*"er 25( 2015

P7<(EN0 (E0-DS:

CE>5E: Please mae *our che?ue pa*able to: Southlands P.7.C.@ and +rite *our childAs name and division in thememo portion. 0here is a !&".## 9ee 9or NSB che?ues. -rders returned to school +ithout che?ues C7NN-0 beprocessed.

S7/(7S0EC7D: Bor char%es made to S7/(astercard F there +ill be an additional credit card processin% 9ee o9 1.) char%ed. Please turn over pa%e and 9ill in the re?uested in9ormation.

Southlands Elementar* ot Do%/Pi,,a Da*

0he 9ollo+in% in9ormation is re?uired 9or isa/(astercard pa*ment:

Name on card: _____________________________________________________ 

Email address o9 cardholder: _________________________________________ 

Postal code attached to the billin% address o9 the card: ___________________ 

Credit card number: _________________________________________________ 

Epiration date: _____________________________________________________ 

C number ;di%it number on the bac o9 the card: _____________________ 

7/17/2019 Hot Dog & Pizza Fall 2015

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SOUTHLANDS ELEMENTARY HOT DOG AND PIZZA LUNCH PROGRAM – FALL SEMESTER 2015Please retr! "# !$ later t%a! Fr&'a#( Se)te*"er 25( 2015

-$5N0EE SGN 5P:

0his pro%ram +ould not be possible +ithout the help and contributions 9rom Southlands ParentsH

9 *ou are interested in volunteerin%@ please 9ill out the 9orm belo+ and return to the o99ice. 0hans in advance 9orhelpin% to mae this pro%ram a successH

olunteer times 9or ot do% da*s are 9rom 11:##am 1&:;#pmI Pi,,a da*s are 9rom 11:1" am 1&:;#pm. Pleaseremember to include all o9 the details on the 9orm belo+. 0han *ouH

Name: ___________________________________________________

Phone: __________________________________________________ 

Email: ___________________________________________________

 7vailabilit* please speci9*:

-nce per month: _______ 

 - Speci9ic dates: _________________________________