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Cristo Rey Jesuit High School

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Nutrition Services Request Form

**Orders must be received by Wednesday for delivery that Friday - otherwise you will receive deliveries starting the following Friday.

This year, every Friday, we will be providing meal bundle packs containing 7 breakfasts & 7 lunches.  These packs serve as the 5 meals for the following week – Monday through Friday, plus 2 weekend meals.  Home delivery or curbside pickup will occur the Friday prior to the week.  Students must pack their own lunch daily to bring to school or work or to eat at home.  Below is the order form and consent form for delivery.  These meal packs are for Cristo Rey Students PLUS any child 18 years and under living in the home (do not include adults) – any additional food requested will be in the form of donated goods as supplies last.

A parent or guardian MUST consent for you to receive home delivery.

If choosing curbside, parents may pick up food for their students - students do not need to be present for delivery or pick up but the student's name must be provided for reimbursement purposes. 

Any questions can be directed to margaretschmidt@cristoreytc.org or 612-545-9902

Please complete the form below to indicate your interest. Required fields marked with an asterisk *

Por favor completa la applicacion debajo para indicar su interés. Los campos requeridos tienen un asterisco *

Grade/ Grado *
Answer Required
Food delivered or picked up will be the bundle packs for school breakfasts & lunches. Occasionally, we may have canned goods and other groceries that we can bring. Check here if you would like additional groceries (if available) for your household:
Answer Required
How do you prefer to receive food?/ ¿Como prefiere recibir su comida?*
Answer Required

School Nutrition Program Consent for
Home Meal Delivery Distance Learning School Year 2020-21

Meals will be provided via home delivery only for students enrolled in the school.

I understand that household contact information may be shared with school staff, volunteer deliverers or private delivery vendors such as bus transportation contractors. I also give consent for meals to be left at doorstep if no one is home at the time of delivery or responds to the delivery. I understand it is my responsibility to ensure the proper safety and protection of meals if no one is home.

By entering your name below, you are agreeing to the terms above:

Non-discrimination Statement: In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form found online at: https://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; or (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

This institution is an equal opportunity provider.