Student SnackPermission Form
For use by Bee Cave, Lakeway, Lake Pointe, and Serene Hills Elementary Campuses
Parent/Guardian;
The Food & Nutrition Services department operates a computerized student account system for meal purchases. If you would like to place a restriction on your student’s meal or snack purchases, fill out the form below.
Failure to submit this form assumes no snack or meal purchase restrictions.
Student Name:(Type name)Student ID#:(Type ID#)
Campus: (Type One) LWE or LPE or SHE
Grade: (Type grade)
Meal and SnackPurchasing Restriction Options
A meal consists of 3 to 5 components with at least one being a fruit or vegetable. Components are: fruit, vegetable, grain, meat/meat alternate, and milk or small water. Up to 5 components may be selected and still be considered a single meal. If additional items are selected (i.e. a second entrée, water, extra roll, etc.) these items are considered à la carte. All à la carte items are charged individually at the posted prices.
Nutrition information for all food sold can be found at
To select meal/snack purchasing restrictions for your student’s lunch account, please “X” ONE of the following:
I authorize my student to purchase “snack/à la carteon the following days only”
Select which day(s): Mon Tue Wed Thurs Fri
I authorize my student to purchase “snacks/à la carteitems with cash only”
I authorize my student to purchase a “Meal + extra entrée or beverage only”
I authorize my student to purchase “Full meals only - NOà la carte”
(Aminimum of 3 of the 5 components are required per “full” meal)
______
**I DO NOTallow my student to purchase a Bobcat (BCE),Mustang (LWE), Eagle (LPE), or Tiger (SHE) Extra Value Meal(higher priced complete meal).
I understand these restrictions will remain in place unless I request cancellation or modification in writing to the Café.Please allow one week for processing.If you have questions about this form, please contact your Café Manager listed below.
If your child has food allergies, please complete and submit the form located on the FANS website at .
** All dietary restriction requests must be accompanied by a signed doctor’s statement.
Parent/Guardian:(Typing name here indicates acceptance by parent/guardian) Date:(Date)
Once Completed, this form must be saved to your computer and then attached to ane-mail or printed and delivered to the Café Manager at your student’s campus in order to be processed. Please allow one week for processing. Managers as follows:
BCE: Sheila Bussemey 512-533-6274
LWE: Gloria Torres 512-533-6372
LPE: Shana Jones512-533-6523
SHE: Dolores Arriaga 512-533-7414