Example Casis Feasibility Review Form

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HARRISON CENTRAL SCHOOL DISTRICT
PREPAID BREAKFAST/SCHOOL LUNCH FORM
May Use
Account
For Snacks
Student Name
School
Grade
(YES/NO)
Dollar Amount
Total Check Amount
$
Parent/Guardian
Signature
_________________________________________ Date:___________________
Please return this form with your check made payable to Harrison CSD Lunch Fund
and send to:
LMK Middle School Students:
LMK Cafeteria
Harrison CSD
50 Union Avenue
Harrison, NY 10528
Harrison High School Students
Harrison High School Cafeteria
Harrison CSD
255 Union Avenue
Harrison, NY 10528
IMPORTANT
Please issue separate checks for middle school and high school students.
If required, duplicate this form for each building submission.
Please be sure to put your child’s name in the memo portion of your check.
This form is also available on the district web site in the “Documents & Forms” section

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