BREAKFAST/LUNCH PRE-PAYMENT FORM

Enclosed, please find $ ______.______ for the pre-payment of

_______ Breakfast _______ Lunch (please enter number of meals paying for)

Student’s Name: _________________________________________

School Attending: ________________________________________

Grade and Teacher Name: _________________________________

Breakfast Price at ALL schools: $ 1.00

Lunch Price at Berlin and Grafton Elementary Schools: $1.70

Lunch Price at Middle/High School: $1.80

If paying by check, please make payable to Berlin Central School District. Place this form, check or cash in envelope – the sealed envelope should be marked with student’s name, school attending (BES, GES, MS or HS), grade and teacher’s name.

If your child attends Berlin or Grafton Elementary School, the money should be given to student’s teacher. If your child attends the Middle or High School, the money should be given directly to the cashier in the cafeteria.

If paying for more than one child, please use a separate form for each child.

Additional forms can be obtained on the school website, www.berlincentral.org, select Lunch under Quick Links and print out the form or contact the school secretary to have additional forms sent home with your child.

If you have any questions regarding this form, please contact Tammy Whitman at (518) 658-2684, ext. 230.