1. food and drink
2. food
3. grains and pasta

PIZZA DAY ORDER FORM: FEBRUARY—MAY 2015
Orders Are Due By Thursday, January 15th
The PTA is pleased to present the next round of Pizza Day for the 2014-15 school year, and will offer
it by pre-order only. A separate Hot Lunch program will be offered for the alternate Tuesdays. Pizzas
come from Riccardo’s Ristorante and your cost is $2.50 per slice.
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Please fill out a separate order form (next page) for each child, and return the form(s) with your
payment in a SEALED envelope labeled “PTA PIZZA DAY”. Include each child’s name & room
number on the envelope.
Make your check payable to “Dirksen PTA” (although you will need a separate form for each child,
you may write one check per family, as long as you place it with all orders in the same envelope).
On the memo line of your check, please write “Pizza Day”—(important for accounting purposes)
th
The deadline for ordering pizza during this session is Thursday, January 15 . There
MAY be extra leftover slices that we can sell for cash on each Pizza Day, but we cannot guarantee
it. If you want your child to have pizza on Pizza Days, you must return this form with your
payment by the due date.
Because pizzas are ordered at the beginning of each session, late orders will not be accepted.
If your child is absent on a Pizza Day, you may pick up their order at 12:15pm. No credits or
refunds will be given.
If you have any questions or concerns, please contact Shila Khan at [email protected]. Thank you!
Please keep this page and use this section for your records:
February 3, 2015
# Cheese Slices Ordered:
# Sausage Slices Ordered:
February 17, 2015
# Cheese Slices Ordered:
# Pepperoni Slices Ordered:
March 3, 2015
# Cheese Slices Ordered:
# Sausage Slices Ordered:
March 17, 2015
# Cheese Slices Ordered:
# Pepperoni Slices Ordered:
April 7, 2015
# Cheese Slices Ordered:
# Sausage Slices Ordered:
April 21, 2015
# Cheese Slices Ordered:
# Pepperoni Slices Ordered:
May 5, 2015
# Cheese Slices Ordered:
# Sausage Slices Ordered:
May 19, 2015
# Cheese Slices Ordered:
# Pepperoni Slices Ordered:
Check #: ________
Total # Slices Ordered: ____ x $2.50 a slice = Total Amt. Paid: $________
PIZZA DAY ORDER FORM: FEBRUARY—MAY 2015
Please Return Order Form (this page only) By Thursday, January 15th
Student’s Name: ____________________________________Teacher & Room #: _______________________
Parent Name (print): ____________________________________ Phone: _____________________________
Email (print): ___________________________________ Payment: CASH
or CHECK
#_________
Total # Slices Ordered: ________ x $2.50/Slice = Total Amount Enclosed: $________
RD
TUESDAY, FEBRUARY 3 : $2.50/Slice. Choice of Cheese or Sausage (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Sausage
2 Slices of Sausage
Order Total: $ _________
TH
TUESDAY, FEBRUARY 17 : $2.50/Slice. Choice of Cheese or Pepperoni (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Pepperoni
2 Slices of Pepperoni
Order Total: $ _________
RD
TUESDAY, MARCH 3 : $2.50/Slice. Choice of Cheese or Sausage (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Sausage
2 Slices of Sausage
Order Total: $ _________
TH
TUESDAY, MARCH 17 : $2.50/Slice. Choice of Cheese or Pepperoni (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Pepperoni
2 Slices of Pepperoni
Order Total: $ _________
TH
TUESDAY, APRIL 7 : $2.50/Slice. Choice of Cheese or Sausage (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Sausage
2 Slices of Sausage
Order Total: $ _________
ST
TUESDAY, APRIL 21 : $2.50/Slice. Choice of Cheese or Pepperoni (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Pepperoni
2 Slices of Pepperoni
Order Total: $ _________
TH
TUESDAY, MAY 5 : $2.50/Slice. Choice of Cheese or Sausage (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Sausage
2 Slices of Sausage
Order Total: $ _________
TH
TUESDAY, MAY 19 : $2.50/Slice. Choice of Cheese or Pepperoni (2 slices maximum)
1 Slice of Cheese
2 Slices of Cheese
1 Slice of Pepperoni
2 Slices of Pepperoni
Order Total: $ _________