Moriah Lunch Order Form

Please note, December's last day is in the middle of the week. When you are done with this month's order, you might want to consider ordering for January as well.

Parent's First Name

Parent's Last Name

Student's First Name

Student's Last Name

Student's Grade/Class

Parent's Email

Parent's Cell

Please now make the selections for each day

Day	Date	* Weekly Snacks: Pick up only during lunch period Meal Option
Monday	December 30, '24	Garden Green Salad with Scoop of Tuna - $11 Mozzarella Sticks with marinara dipping sauce - $9 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Chocolate Chip Ice Cream Sandwich* - $4 Snack Special: Pickle on a Stick - $4 Kettle Cooked Potato Chips* - $2 Popcorn* - $2 Blue Gatorade* - $2 Red Gatorade* - $2 Peach Snapple* - $2 Lemon Snapple* - $2
Tuesday	December 31, '24	Deli Salad- Crisp Romaine, Tomatoes, Red Peppers, Red Onion, Cucumber, Sliced Turkey - $11 Sliders on Pretzel Buns with Chef Special Sauce - $10 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Snack Special: Pickle on a Stick - $4 Kettle Cooked Potato Chips* - $2 Popcorn* - $2 Blue Gatorade* - $2 Red Gatorade* - $2 Peach Snapple* - $2 Lemon Snapple* - $2
		I am currently on the lunch program
Total Meals:		0
Total Cost:		$0

Credit Card Number

Expiration

CVV

Card Owner's name

Billing Address ZIP

Order for January 2025 December 2024

Order for January 2025
December 2024