* First Name: * Last Name: * Email Address: Last name of child #1 First name of child #1 Grade of child #1 JKA JKB SKA SKB 1A 1B 2A 2B 3A 3B 4A 4B 5A 5B 6A 6B 7A 7B 8A 8B Milk All Tuesdays and Wednesdays (68 Days - All Special Lunch Days included) Child #1 1 White MIlk $47.60 2 White Milk $95.20 1 Chocolate Milk $47.60 2 Chocolate Milk $95.20 Milk Tuesdays Only (34 Days - Tuesday Special Lunch Days included) Child #1 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Milk Wednesdays Only (34 Days - Wednesday Special Lunch Days included) Child #1 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Tuesday, October 5 Special Lunch Child #1 no longer available for order Tuesday, October 5 Milk Child #1 no longer available for order Wednesday, October 20 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, October 20 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, November 2 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, November 2 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, November 17 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, November 17 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, December 7 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, December 7 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, January 5 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, January 5 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, January 18 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, January 18 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, February 1 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, February 1 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, February 16 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, February 16 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, March 1 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, March 1 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, March 23 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, March 23 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, April 5 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, April 5 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, April 20 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, April 20 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, May 10 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, May 10 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, June 1 Special Lunch Child #1 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, June 1 Milk Child #1 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 LINE A: TOTAL AMOUNT FOR CHILD #1 Last Name of Child #2 First Name of Child #2 Grade of Child #2 JKA JKB SKA SKB 1A 1B 2A 2B 3A 3B 4A 4B 5A 5B 6A 6B 7A 7B 8A 8B Milk All Tuesdays and Wednesdays (68 Days - All Special Lunch Days included) Child #2 1 White MIlk $47.60 2 White Milk $95.20 1 Chocolate Milk $47.60 2 Chocolate Milk $95.20 Milk Tuesdays Only (34 Days - Tuesday Special Lunch Days included) Child #2 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Milk Wednesdays Only (34 Days - Wednesday Special Lunch Days included) Child #2 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Tuesday, October 5 Special Lunch Child #2 no longer available for order Tuesday, October 5 Milk Child #2 no longer available for order Wednesday October 20 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday October 20 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday November 2 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday November 2 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday November 17 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday November 17 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, December 7 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, December 7 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, January 5 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, January 5 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, January 18 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, January 18 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, February 1 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, February 1 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, February 16 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, February 16 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday March 1 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday March 1 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday March 23 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday March 23 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, April 5 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, April 5 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, April 20 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, April 20 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, May 10 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, May 10 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, June 1 Special Lunch Child #2 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, June 1 Milk Child #2 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 LINE B: TOTAL AMOUNT FOR CHILD #2 Last Name of Child #3 First Name of Child #3 Grade of Child #3 JKA JKB SKA SKB 1A 1B 2A 2B 3A 3B 4A 4B 5A 5B 6A 6B 7A 7B 8A 8B Milk All Tuesdays and Wednesdays (68 Days - All Special Lunch Days included) Child #3 1 White MIlk $47.60 2 White Milk $95.20 1 Chocolate Milk $47.60 2 Chocolate Milk $95.20 Milk Tuesdays Only (34 Days - Tuesday Special Lunch Days included) Child #3 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Milk Wednesdays Only (34 Days - Wednesday Special Lunch Days included) Child #3 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Tuesday, October 5 Special Lunch Child #3 no longer available for order Tuesday, October 5 Milk Child #3 no longer available for order Wednesday, October 20 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, October 20 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, November 2 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, November 2 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, Novermber 17 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, Novermber 17 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, December 7 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, December 7 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, January 5 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, January 5 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, January 18 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, January 18 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, February 1 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, February 1 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, February 16 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, February 16 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, March 1 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, March 1 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, March 23 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, March 23 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, April 5 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, April 5 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, April 20 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, April 20 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, May 10 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, May 10 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, June 1 Special Lunch Child #3 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, June 1 Milk Child #3 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 LINE C: TOTAL AMOUNT FOR CHILD #3 Last Name of Child #4 First Name of Child #4 Grade of Child #4 JKA JKB SKA SKB 1A 1B 2A 2B 3A 3B 4A 4B 5A 5B 6A 6B 7A 7B 8A 8B Milk All Tuesdays and Wednesdays (68 Days - All Special Lunch Days included) Child #4 1 White MIlk $47.60 2 White Milk $95.20 1 Chocolate Milk $47.60 2 Chocolate Milk $95.20 Milk Tuesdays Only (34 Days - Tuesday Special Lunch Days included) Child #4 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Milk Wednesdays Only (34 Days - Wednesday Special Lunch Days included) Child #4 1 White MIlk $23.80 2 White Milk $47.60 1 Chocolate Milk $23.80 2 Chocolate Milk $47.60 Tuesday, October 5 Special Lunch Child #4 no longer available for order Tuesday, October 5 Milk Child #4 no longer available for order Wednesday, October 20 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, October 20 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, November 2 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, November 2 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, November 17 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, November 17 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, December 7 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, December 7 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, January 5 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, January 5 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, January 18 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, January 18 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, February 1 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, February 1 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, February 16 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, February 16 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, March 1 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, March 1 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday March 23 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday March 23 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, April 5 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, April 5 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, April 20 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, April 20 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Tuesday, May 10 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Tuesday, May 10 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 Wednesday, June 1 Special Lunch Child #4 1 Slice Pizza $1.50 2 Slices Pizza $3.00 3 Slices Pizza $4.50 1 Sub $1.75 2 Subs $3.50 Wednesday, June 1 Milk Child #4 1 white milk $0.70 2 white milk $1.40 1 chocolate milk $0.70 2 chocolate milk $1.40 LINE D: TOTAL AMOUNT FOR CHILD #4 * TOTAL AMOUNT DUE: LINE A + LINE B + LINE C + LINE D PAYMENT TYPE
Total Amount Included with "Additional Fees" Cheque (found in the August mailing package) Nine post-dated cheques * Enter the code displayed:
