Pizza and Chicken Order Form
To order your lunch service online, please complete this form and then proceed to our online store for payment. We will provide a payment link and additional instructions on the order confirmation page. If you order online, you must pay online. Orders are not considered submitted until the online payment is received.
 
Parent's Full Name:  
 

Pizza:
Child's Name
# of PLAIN Slices
# of Pepperoni Slices
Check if Not Participating
Teacher Name Grade
Subtotals by slice:      
Total Pizza cost per week (at $1.00 per slice):
 
Total Pizza cost for the term (weekly cost X weeks)
 

Chick-Fil-A®:
Child's Name
# of
8-peice CHICKEN Nugget boxes

# of CHICKEN Sandwiches
Check if Not Participating
Teacher Name Grade
Subtotal by Item:
         
Weekly Chicken Cost (at $2.25 per item):  
 
Total Chicken cost for term (weekly cost X weeks):
 

Total cost of order:  

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911 Generals Hwy, Millersville, MD 21108 - P: 410-923-1171 - learning@rockbridge.org