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Food Delivery Receipt
Children ages 3-5 years
CACFP Institution : ___________________________________ Date : _______________
Food Service Vendor: ________________________________
Breakfast Number of Meals Provided:
Component
Item
Serving Size
(3-5 Years)
Total Weight/
Measure Provided
Fruit/Vegetable
½ cup
Bread/Alternate
½ slice
Milk
3/4 cup
Meat/Alternate (opt.)
none required
Extras
Lunch Number of Meals Provided:
Component
Item
Serving Size
(3-5 Years)
Total Weight/
Measure Provided
Meat/Alternate
1 ½ oz.
Fruit/Vegetable
1/4 cup
Fruit/Vegetable
1/4 cup
Bread/Alternate
1/2 oz. Or ½ slice
Milk
3/4 cup
Extra
Snack Number of Meals Provided:
Component
Item
Serving Size
(3-5 Years)
Total Weight/
Measure Provided
Meat/Alternate
1/2 oz.
Fruit/Vegetable
½ cup
Bread/Alternate
1/2 oz. Or 1/2 slice
Milk
1/2 cup
Extra
Acceptance of delivery:
Signature ______________________________________ Date _____________________
USDA is an equal opportunity provider and employer