a' la carte at Amery High School - School District of Amery

Permission to Purchase
a’ la Carte Food Items at Amery High School

The School District of Amery’s a’ la carte program at Amery High School operates independently from the National School Lunch Program. Beverages, sandwiches, pizza and snack items are available for students to purchase at designated meal times. These food items may be purchased with cash in the line. Items may be charged to the student’s family account only if a positive balance is in the account and a copy of this form is on file in the School Nutrition Office. A’ la carte items may not be charged if there is a negative balance in the account.

Please complete and submit the form below if you wish to allow your student to charge a’ la carte items to your family account. This permission form will remain on file for subsequent school years, but may be changed or removed at any time by notifying the School Nutrition Office at 715-268-9771, ext. 255 or paulsonc@amerysd.k12.wi.us.

A' la Carte Permission Form:

Student Name:

Parent/Guardian Name:

Parent/Guardian Contact Phone Number (used for form confirmation):

Home Address:

Family Meal Account Number:

Date Permission Form is to be Active:

I give permission for my student to charge a' la carte items to my family meal account. I understand that purchases may only be charged if the account has a positive balance.

(1 required)

Yes

By submitting this form to the School District of Amery, I agree that my student may charge a' la carte items to my family meal account. I understand that I may revoke this permission statement at any time by contacting the District's School Nutrition Office. I also understand that I will be contacted by the School Nutrition Office to confirm this permission form.

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