Parent Ala Carte Restriction Request

Parent Ala Carte Restriction Request

Parent/Guardian Ala Carte Restriction Request
NEW - School Year 2019-20

Parent/Guardian can add or remove a purchasing restriction to a student's cafeteria account by completing this form.  Student accounts with this restriction will be blocked from the purchase of ala carte foods in the school cafeteria at breakfast, lunch, and after school.  Ala Carte foods include both non-meal items (chips, snacks, drinks) and extra servings of meal items (extra entrees, extra milks, extra sides). 

All restrictions will be in place for (1) school year unless parent removes this request during the school year.  All restrictions will be removed over summer and must be made again for a new school year.

Reminder:  Account purchases can be monitored for FREE on www.EZSchoolPay.com even if you are not using the app/website to pay.  This is an easy way for multiple parents/guardians or even the student to use the app to monitor the account purchases and balance.

 

Student Last Name  

Student First Name  

School  

Grade:  

Date of Birth    /    /  


 

Are you requesting to ADD or REMOVE the ala carte restriction to this student's account?

  ADD= No la carte purchases will be allowed

  REMOVE= Previously requested restriction removed (ala carte purchases will now be allowed)


 

Person completing this form:

I certify that I am the Parent/Guardian of the above student and the person responsible for funding this account.

First/Last Name (Electronic Signature):  

Email Address:  

 



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