Building:___ Houghton
___ Woodland Meadows
___ Pleasant Ridge
___ Harvest
___ Heritage
___ Middle School
___ High School
Name of Student: ____________________________________________
Phone Number: ________________________
Teacher’s Name: ________________________
Room Number: ________________________
Date item needed: _________________________
Item: __________________________________
Quantity: __________________
Payment required at time of order:
Payment by check made payable to:Saline Area Schools enclosed with order form or by deduct the payment from the lunch account of the birthday child.
Deduct from birthday child's lunch account ___ Yes ___ No
Name: _____________________________
Address: ___________________________
Phone No: __________________________