Student's Name

Class

- Select Dietary Restrictions - Gluten Free Dairy Free No Beef Vegetarian

Full Month: June 4 - June 29 - add $100.00
Week 1: June 4 - June 8 - add $25.00
Week 2: June 11 - June 15 - add $25.00
Week 3: June 18 - June 22 - add $25.00
Week 4: June 25 - June 29 - add $25.00

Please enter the dates you would like to order a sandwich (I.E.: 5/5, 5/6, 5/7 . . . )