Waterloo Central School District
Waterloo Central School District Food Services Department
Brian Corey, School Lunch Manager
SCHOOL BREAKFAST/LUNCH PREPAYMENT FORM
STUDENT NAME______________________________SCHOOL _______________________________
This form is used to deposit money into your child's Lunch Account. Additional forms can be picked up in the school cafeteria or on our website. (This is optional) You can still pay cash daily through the lunch line or pay online at myschoolbucks (Accounts will need to be set up online). Call 539-1556 if assistance is needed.
Instructions: Complete the information below:
Send payment with this form in a sealed envelope to your child’s cafeteria, or mail to
Your school – Attn: Cafeteria.
If payment is in the form of a check, make check payable to “Waterloo School Lunch Fund”
Skoi Yase Primary School 65 Fayette St. Waterloo, NY 13165
LaFayette Intermediate School 7l Inslee St. Waterloo, NY 13165
Waterloo Middle School 65 Center St. Waterloo, NY 13165
Waterloo High School 96 Stark St. Waterloo, NY 13165
The prepayment plan is recommended for our Breakfast and Lunch Program. Each student has their own account. This payment method will decrease the student’s wait in the cafeteria line and allow him/her more time to eat.
Be sure to specify on your check or envelope how you would like the money distributed.
(Meals only or Meals and Snacks)
Amount______________________
Check Number ________________
Meals Only________ Meals and Snacks_________
* Allergies ___________________________________________________________________
* Must be accompanied by a physician’s excuse
Breakfast Meal Prices (K-12) $1.45 Free & Reduced Breakfast (K-12) $0.00
Lunch Meal Prices (K-5) $2.25 (6-12) $2.50- Free & Reduced Lunch (K-12) $0.00
If you have any questions or concerns, feel free to contact the Food Service Office @ 539-1464 or 539-1556 or email to brian.corey@
PARENT/GUARDIAN SIGNATURE______________________________ DATE_____________________ Revised 7/19
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