Saxapahaw General Store Lunch Program Registration - Second Semester 2018
(* required fields)

Student Name:*
Student E-mail:
Student Phone:
Parent Name:*
Parent E-mail:*
Parent Phone:*
Dietary preference:*
Does the student have any food allergies or other dietary restrictions?:*
If "Yes," please describe:

Choose your meal plan
(After you submit this form you will be taken to PayPal where you can pay either with your PayPal account or a credit card.)

Your lunch plan:*
Feedback: Tell us what your child enjoys and needs:
Please retype this text to verify your submission:

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