LUNCH FEE

FAMILY NAME:  ___________________________

# of children:   ________________

Amount due:     $100.00 per child for the year.

                        $50.00 due by 9/18/09; $50.00 due by 1/21/10

Amount enclosed:  ___________

OFFICE USE ONLY

DATE: ____________

_____ CASH

_____ CHECK #____________

_____ M.O. # ______________

Received by:  ______________