• Lunch Break Student Enrollment Form

    Enroll your student for the Lunch Break Meal Prep school lunch program. Use the mobile-friendly layout and complete all fields.
  • Student Information

  • Parent Details

  • Format: (000) 000-0000.
  • Preferred Contact Method
  • Meal Plan & Preferences

  • Dietary Preference*
  • 1st Delivery Date for the Month (Sunday deliveries will begin in October)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2nd Delivery Date for the Month (Sunday deliveries will begin in October)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 3rd Delivery Date for the Month (Sunday deliveries will begin in October)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 4th Delivery Date for the Month (Sunday deliveries will begin in October)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 5th Delivery Date for the Month (Sunday deliveries will begin in October)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Allergies & Restrictions

  • Allergies and Restrictions
  • Format: (000) 000-0000.
  • Photo Consent: May we use photos of your child enjoying Lunch Break Meals?*
  • Liability Waiver: By enrolling your child in Lunch Break’s Meal Prep program, you acknowledge and assume all risks associated with food consumption prepared by Lunch Break Meal Prep. Lunch Break Meal Prep and the School assume no liability for adverse reactions, including but not limited to allergic reactions, foodborne illnesses, choking hazards, or contamination resulting from food preparation, handling, storage, or serving. Parents are solely responsible for disclosing all known food allergies and dietary restrictions to Lunch Break Meal Prep in writing. Lunch Break Meal Prep operates from a commercial kitchen inspected and approved by the Department of Agriculture and local health department, with all employees ServSafe certified. Despite these safety measures and protocols, Lunch Break is not responsible for cross-contamination, ingredient substitutions, or nutritional inaccuracies. By signing below, you waive claims against Lunch Break Meal Prep and the School related to food consumption and accept full responsibility for your child’s dietary health and safety.

  • Arbitration Clause: Any disputes, claims, or controversies arising from this program shall be resolved exclusively through binding arbitration rather than litigation. Both parties agree to submit to arbitration before a neutral third party arbitrator and waive the right to pursue claims in court or through class action. Arbitration costs shall be shared equally unless otherwise determined by the arbitrator.

  • Consent & Signature

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: