STUDENT LUNCHROOM DEPOSIT FORM

TO BE RETURNED WITH ADVANCED PAYMENT

Student's Name ____________________ PIN# ___________ Grade _______

Parent or Guardian Name ___________________________________________________

Check Amount ___________ Check # _________  Cash Amount __________

(please make checks payable to: Newbury Local School District)

____________________________________________________________________________________

STUDENT LUNCHROOM DEPOSIT FORM

TO BE RETURNED WITH ADVANCED PAYMENT

Student's Name____________________ PIN# _________Grade__________

Parent or Guardian Name ______________________________________________________

Check Amount ________ Check # ___________ Cash Amount__________

(please make check payable to: Newbury Local School District)