Moriah Lunch Order Form

Order for November 2024
October 2024

Please fill out the following form to order lunches for your child. Note, if you have multiple children you would like to order for, you must please fill out this separately for each child.

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
Wednesday	October 16, '24
Thursday	October 17, '24
Monday	October 21, '24
Tuesday	October 22, '24
Wednesday	October 23, '24
Thursday	October 24, '24
Monday	October 28, '24	Greek Salad with Crumbled Feta Cheese - $11 Pizza Rolls with Marinara Dipping Sauce - $9 Snack Special: Tortilla Chips with Salsa - $6 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Chocolate Chip Ice Cream Sandwich* - $4 Kettle Cooked Potato Chips* - $2 Popcorn* - $2 Blue Gatorade* - $2 Red Gatorade* - $2 Peach Snapple* - $2 Lemon Snapple* - $2
Tuesday	October 29, '24	Grilled Chicken Salad - $11 Breaded Chicken Sandwich with Potato Tots - $10 Snack Special: Tortilla Chips with Salsa - $6 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Kettle Cooked Potato Chips* - $2 Popcorn* - $2 Blue Gatorade* - $2 Red Gatorade* - $2 Peach Snapple* - $2 Lemon Snapple* - $2
Wednesday	October 30, '24	Tropical Acai Bowl- Yogurt topped with Granola and Tropical Fruit Mix - $11 Berry Acai Bowl- Yogurt topped with Granola, Strawberries and Blueberries - $11 Taco Salad- Seasoned Taco Meat, shredded lettuce, Tomatoes, corn, cucumber, olives and beans - $11 Hotdog on bun with Curly Fries - $10 Snack Special: Tortilla Chips with Salsa - $6 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Kettle Cooked Potato Chips* - $2 Popcorn* - $2 Blue Gatorade* - $2 Red Gatorade* - $2 Peach Snapple* - $2 Lemon Snapple* - $2
Thursday	October 31, '24	Cheese Bourekas with Tater Tots - $9 Baked Potato Topped with Broccoli and Cheese - $8 Weekly Desert Special- Hot Pretzel with Mustard Dipping Sauce - $6 Snack Special: Tortilla Chips with Salsa - $6 Giant Marshmallow Rice Crispy Square* - $6 Fruit Cup* - $6 Chocolate Chip Ice Cream Sandwich* - $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