SUMMER FOOD SERVICE PROGRAM
MEAL COUNT RECORD

Site:______________________                  Meal (please circle one):    Breakfast      Lunch      Snack      Dinner   
Day and Date:____________________________

Supervisor:_______________________  Delivery Time:___________  Meal Service Time: _______to________
___________________________________________________________________________________________

								Total Meals Received/Prepared:			

First Meals to Children: Please circle a number for each complete meal provided to children (1 per child)
only meals served to children can be claimed. First meals will receive full reimbursement. If second meals are served, they  must be recorded separately. 
1       	  2	   3	   4	   5	   6	   7	    8	    9	   10
11 	12	 13	 14     	 15	 16	 17	  18	  19	   20	
21	22	 23	 24	 25	 26	 27	  28	  29 	   30
31	32	 33	 34	 35	 36	 37	  38	  39	   40	
41	42	 43	 44	 45	 46	 47	 48	  49	   50
51	52	 53	 54	 55	 56	 57	 58	  59	   60
61 	62	 63	 64	 65	 66	 67	 68	  69 	   70
71	72	 73	 74	 75	 76	 77	 78	  79	   80
81	82	 83	 84	 85	 86	 87	 88	  89  	   90

91	92	 93	 94	 95	 96	 97	 98	  99	 100	
										     Total First Meals:    
Second Meals to Children:
1	  2	  3	  4	  5	  6	  7	  8	   9	  10
11	12	13	14	15	 16	 17	 18	 19	  20

Comments

By signing below, I certify that the above information is true  and accurate:

      ____________________________
	Site Supervisor’s Signature

	   	                                                                                                    Total Second Meals    ___________
	 												
 					   Total non-reimbursable meals (adults and program adults)   ___________
											     
									              Total Leftover Meals      ___________

													

	

	101	 102	 103	 104	 105	 106	 107	 108	 109	 110

	111	 112	 113	 114	 115	 116	 117	 118	 119	 120

	121	 122	 123	 124	 125	 126	 127	 128	 129	 130

	131	 132	 133	 134	 135	 136	 137	 138	 139	 140

	141	 142	 143	 144	 145	 146	 147	 148	 149	 150

	151	 152	 153	 154	 155	 156	 157	 158	 159	 160

	161	 162	 163	 164	 165	 166	 167	 168	 169	 170

	171 	 172	 173	 174	 175	 176	 177	 178	 179	 180

	181	 182	 183	 184	 185	 186	 187	 188	 189	 190

	191	 192	 193	 194	 195	 196	 197	 198	 199	 200