CHILD’S NAME _________________________________ WEEK OF ___________________________
MONDAY – Hardee's Total for Monday $ ___________________
Regular Hamburger $2.50 _____ Regular Cheeseburger $2.50____ Hambeurger Little Thickburger $3.25 ____ cheeseburger Little Thickburger
$3.25 ____ Small French Fries $1.50 ______ Hot Dog $3.00 ____ Hot Dog w/chili $3.25 ____ Chicken Tenders (2), Fries, sauce $4.00 ___
Hot Ham&Cheese $3.00 ____ Lunch Salad (Ham or Chicken) $3.29 ____
Milk and Juice $0.50 _____ Tea $1.00 _____ O.J., Apple Juice, Water $1.25_____
$1.25 snack_____ $1.00 snack_____ $0.50 snack_____ $0.75 snack_____
$0.75 ice cream_____ $1.25 ice cream_____ $1.50 ice cream_____
TUESDAY – ZAXBY’S – TOTAL FOR TUESDAY $__________
Chicken Finger Dinner $5.00_____ Chicken Finger Sandwich$4.25_____
Kiddie Finger Meal $3.25_____ Side Salad $2.00_____
Milk and Juice $0.50 _____ Tea $1.00 _____ O.J., Apple Juice, Water $1.25_____
$1.25 snack_____ $1.00 snack_____ $0.50 snack_____ $0.75 snack_____
$0.75 ice cream_____ $1.25 ice cream_____ $1.50 ice cream_____
WEDNESDAY – ARBY’S – TOTAL FOR WEDNESDAY $__________
Sandwiches
Roast Beef $2.75_____ Beef-n-Cheddar $2.85_____ Ham&Swiss $2.25_____ Chicken $3.50_____
Chicken, Bacon,&Swiss $3.50_____ Chicken Cordon Bleu $3.50_____
Medium Curly Fries $1.50 _____ Entrée Salad $5.25_____
Milk and Juice $0.50 _____ Tea $1.00 _____ O.J., Apple Juice, Water $1.25_____
$1.25 snack_____ $1.00 snack_____ $0.50 snack_____ $0.75 snack_____
$0.75 ice cream_____ $1.25 ice cream_____ $1.50 ice cream_____
THURSDAY – CICI’S – TOTAL FOR THURSDAY $__________
Pizza $2.00 slice
Cheese_____ Garlic Cheesebread $4.00_____ Salad (Italian or BLT) $4.00 _____
Pepperoni_____ Garlic Sticks $4.00_____ Mini Cinnamon Rolls $3.00_____
Sausage_____
Milk and Juice $0.50 _____ Tea $1.00 _____ O.J., Apple Juice, Water $1.25_____
$1.25 snack_____ $1.00 snack_____ $0.50 snack_____ $0.75 snack_____
$0.75 ice cream_____ $1.25 ice cream_____ $1.50 ice cream_____
FRIDAY – CHICK-FIL-A – TOTAL FOR FRIDAY $__________
Original Chicken Sandwich $3.75_____ 8 Nuggets $3.50_____ Chicken Salad Sandwich $3.75_____
Cole Slaw $1.50_____ Carrot Salad$1.50_____ Brownie $1.25_____ Side Salad $2.50_____
Fruit Cup $2.50_____ Salad (chargrill, fried, Santa Fe) $5.75_____
Cool Wrap (chargrill,Caesar, spicy) $4.75_____
Milk and Juice $0.50 _____ Tea $1.00 _____ O.J., Apple Juice, Water $1.25_____
$1.25 snack_____ $1.00 snack_____ $0.50 snack_____ $0.75 snack_____
$0.75 ice cream_____ $1.25 ice cream_____ $1.50 ice cream_____
TOTAL FOR WEEK $_______________________
TURN IN FORM AND MONEY ON MONDAYS