Moriah Lunch Order Form

May 2022

Please fill out the following form to order lunches for your child. Note, if you have multiple children you would like to order for, you must please fill out this separately for each child.

Parent's First Name

Parent's Last Name

Student's First Name

Student's Last Name

Student's Grade/Class

Parent's Email

Parent's Cell

Please now make the selections for each day

Day	Date	Meal Option
Monday	May 23, '22	Sushi - Spicy Tuna Roll - $6 Sushi - California Roll - $6 Sushi- Teriyaki Salmon - $6 Sushi - Cucumber Avocado Roll - $6 Sushi - Cucumber Roll - $6 Rainbow Chop Salad- Romaine, tomatoes, cucumbers, carrots, corn, black beans, peppers, hard cooked egg & Cheddar Cheese - $7 Mozzarella Sticks with marinara dipping sauce & side garden salad - $7
Tuesday	May 24, '22	Sushi - Spicy Tuna Roll - $6 Sushi - California Roll - $6 Sushi- Teriyaki Salmon - $6 Sushi - Cucumber Avocado Roll - $6 Sushi - Cucumber Roll - $6 Taco Salad- Seasoned Taco meat, Shredded Lettuce, tomatoes, corn, cucumbers, olives & beans - $8 Baked Chicken Fries- served with Onion Rings - $8
Wednesday	May 25, '22	Sushi - Spicy Tuna Roll - $6 Sushi - California Roll - $6 Sushi- Teriyaki Salmon - $6 Sushi - Cucumber Avocado Roll - $6 Sushi - Cucumber Roll - $6 Chicken Caesar Salad - $8 Pastrami Egg Rolls with mustard dip, pickles and Side of Coleslaw - $8
Thursday	May 26, '22	Sushi - Spicy Tuna Roll - $6 Sushi - California Roll - $6 Sushi- Teriyaki Salmon - $6 Sushi - Cucumber Avocado Roll - $6 Sushi - Cucumber Roll - $6 Caprese Salad- Mixed Greens, tomatoes, roasted peppers, olives and Fresh Mozzarella Cheese - $7
Monday	May 30, '22
Tuesday	May 31, '22	Sushi - Spicy Tuna Roll - $6 Sushi - California Roll - $6 Sushi- Teriyaki Salmon - $6 Sushi - Cucumber Avocado Roll - $6 Sushi - Cucumber Roll - $6 Buffalo Salad- Crisp Romaine, Tomatoes, Cucumbers, Celery and croutons. Topped with Boneless Buffalo Chicken Tenders - $8 Stadium Dog- Foot Long Hot Dog on a Pretzel Bun - Served with chips and a pickle - $8
		I am currently on the lunch program
Total Meals:		0
Total Cost:		$0

Credit Card Number

Expiration

CVV

Card Owner's name

Billing Address ZIP