ALA Carte Permission Form
WHITEWRIGHT ISD CHILD NUTRITION DEPARTMENT ALA CARTE PERMISSION FORM Dear Parents/Guardians: This is a note in reference to purchasing ala carte and/or snack items. Ice Cream is available on Tuesdays and Thursdays for the Elementary School children and daily for the Middle and High Schools kids. Students must have money with them or in their meal account to purchase any ala carte and/or snack items, Whitewright ISD has a $20.00 Charge limit for meals only (No charges are allowed for ala carte and/or snack items). Parents/Guardians are responsible for keeping their child/children account(s) up to date. Please fill out this permission slip to let us know if you allow your child to purchase any ala carte and/or snack items, how often, and/or how much. Student’s Name: ________________________________________________ Grade: ________________ Please mark below as many as may apply to your child: ______ Allow to purchase ala carte and/or snack items if my child has money in his/her meal account. ______ Allow my child to purchase ala carte and/or snack items only on the following date(s): _____________ ______ Allow my child to purchase only the following ala carte and/or snack items: ______________________ Muffins: $0.50 Ice Cream: $0.75 Extra side: $0.50
Chips: $0.50 Rice Krispies: $0.75 Extra Breakfast entrée: $0.75
Capri Sun: $0.50 Big Water: $1.00 Extra Lunch entrée: $1.50
Scooby Snacks: $0.50 Goldfish: $0.50 Small Water: $0.50
Please Sign, Date & Return to the school: Parent/Guardian Name: ________________________________ Date:___________ We appreciate your cooperation in making your child’s meal time a pleasant experience, Thank You, Sandra K Whitt, CND 903-364-2155 x106 [email protected] We have an online prepayment system available: www.whitewrightisd.com, click on Cafeteria, then www.myschoolbucks.com, setup an account to monitor your child’s account balances, purchases, etc. In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible State or local Agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information is available in languages other than English. To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410 fax: (202) 6907442; or email: [email protected]. This institution is an equal opportunity provider.
Chips: $0.50 Rice Krispies: $0.75 Extra Breakfast entrée: $0.75
Capri Sun: $0.50 Big Water: $1.00 Extra Lunch entrée: $1.50
Scooby Snacks: $0.50 Goldfish: $0.50 Small Water: $0.50
Please Sign, Date & Return to the school: Parent/Guardian Name: ________________________________ Date:___________ We appreciate your cooperation in making your child’s meal time a pleasant experience, Thank You, Sandra K Whitt, CND 903-364-2155 x106 [email protected] We have an online prepayment system available: www.whitewrightisd.com, click on Cafeteria, then www.myschoolbucks.com, setup an account to monitor your child’s account balances, purchases, etc. In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible State or local Agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information is available in languages other than English. To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410 fax: (202) 6907442; or email: [email protected]. This institution is an equal opportunity provider.
