PTG Pizza Lunch sign-up

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Number of Students: REQUIRED Please fill out this field.
Student 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level: REQUIRED Please fill out this field.
- Pizza Lunch Dates are always on a Friday. Please select the month(s) for your child(ren). REQUIRED Friday, September 22 Friday, October 20 Friday, November 17 Friday, December 15 Friday, January 12 Friday, February 23 Friday, March 22 Friday, April 19 Friday, May 17 Please fill out this field.
- Drink selection REQUIRED Milk Chocolate Milk Water Please fill out this field.
- NOTE: Amounts for the options are calculated to include the mandatory electronic processing fee of 3%.
- Pizza Lunch Program Options - number of slices and drink REQUIRED
  54.0 – 2 slices/drink for entire year (total of 9 lunches)
  72.0 – 3 slices/drink for entire year (total of 9 lunches)
  30.0 – 2 slices/drink for half of the year (total of 5 lunches)
  40.0 – 3 slices/drink for half of the year (total of 5 lunches)
  6.0 – 2 slices/drink for one lunch
  8.0 – 3 slices/drink for one lunch Please fill out this field.
Student 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level: REQUIRED Please fill out this field.
- Pizza Lunch Dates are always on a Friday. Please select the month(s) for your child(ren). REQUIRED Friday, September 22 Friday, October 20 Friday, November 17 Friday, December 15 Friday, January 12 Friday, February 23 Friday, March 22 Friday, April 19 Friday, May 17 Please fill out this field.
- Drink selection REQUIRED Milk Chocolate Milk Water Please fill out this field.
- NOTE: Amounts for the options are calculated to include the mandatory electronic processing fee of 3%.
- Pizza Lunch Program Options - number of slices and drink REQUIRED
  54.0 – 2 slices/drink for entire year (total of 9 lunches)
  72.0 – 3 slices/drink for entire year (total of 9 lunches)
  30.0 – 2 slices/drink for half of the year (total of 5 lunches)
  40.0 – 3 slices/drink for half of the year (total of 5 lunches)
  6.0 – 2 slices/drink for one lunch
  8.0 – 3 slices/drink for one lunch Please fill out this field.
Student 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level: REQUIRED Please fill out this field.
- Pizza Lunch Dates are always on a Friday. Please select the month(s) for your child(ren). REQUIRED Friday, September 22 Friday, October 20 Friday, November 17 Friday, December 15 Friday, January 12 Friday, February 23 Friday, March 22 Friday, April 19 Friday, May 17 Please fill out this field.
- Drink selection REQUIRED Milk Chocolate Milk Water Please fill out this field.
- NOTE: Amounts for the options are calculated to include the mandatory electronic processing fee of 3%.
- Pizza Lunch Program Options - number of slices and drink REQUIRED
  54.0 – 2 slices/drink for entire year (total of 9 lunches)
  72.0 – 3 slices/drink for entire year (total of 9 lunches)
  30.0 – 2 slices/drink for half of the year (total of 5 lunches)
  40.0 – 3 slices/drink for half of the year (total of 5 lunches)
  6.0 – 2 slices/drink for one lunch
  8.0 – 3 slices/drink for one lunch Please fill out this field.
Student 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade level: REQUIRED Please fill out this field.
- Pizza Lunch Dates are always on a Friday. Please select the month(s) for your child(ren). REQUIRED Friday, September 22 Friday, October 20 Friday, November 17 Friday, December 15 Friday, January 12 Friday, February 23 Friday, March 22 Friday, April 19 Friday, May 17 Please fill out this field.
- Drink selection REQUIRED Milk Chocolate Milk Water Please fill out this field.
- NOTE: Amounts for the options are calculated to include the mandatory electronic processing fee of 3%.
- Pizza Lunch Program Options - number of slices and drink REQUIRED
  54.0 – 2 slices/drink for entire year (total of 9 lunches)
  72.0 – 3 slices/drink for entire year (total of 9 lunches)
  30.0 – 2 slices/drink for half of the year (total of 5 lunches)
  40.0 – 3 slices/drink for half of the year (total of 5 lunches)
  6.0 – 2 slices/drink for one lunch
  8.0 – 3 slices/drink for one lunch Please fill out this field.

I agree to make all payments/fees & I understand refunds are not available (required to proceed to processing). Please select this field.