HCSD Meal Request Form 2021-22

Harrison Central School District

Meal Pick-up Request Form
All students are entitled to FREE breakfast & lunch meals. If your child is at home learning virtually, you can pick-up free meals for your child by completing this form no later than 3:00 the day prior.
- Pick up time is between 8:00 AM - 10:00 AM each day at the main entrance.
- If there is no school on pick up days, meals will be provided the following school day.
- Please fill out a separate form for each child. If you have children attending more than one school, the cafeteria staff will contact you to make arrangements for a single pick-up location.
If you have any questions, please call 914-630-3114.
Student Name*

First NameLast Name
School*

Harrison High SchoolLouis M. Klein Middle SchoolHarrison Avenue Elementary SchoolParsons Memorial Elementary SchoolPurchase Elementary SchoolSamuel J. Preston Elementary School
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date You Are Requesting Meal Pickup

MonthDayYear
Date
Does your child have a food allergy?*

NOYES
If YES, list this child's food allergies.*
Should be Empty:

Harrison Central School District