Finger Scan Opt Out Form

Student Name: _____________________School:__________

Student Name: _____________________School:__________

Student Name: _____________________School:__________

I request that the above named student(s) not participate in the Finger Scan Identification program.  My student(s) must present their card each time they want to purchase something at the register.  Replacement cards will be charged to the student for $2.00.

Parent Signature: ________________________

Parent Name (Printed): ___________________

Date: ________________

Return this form to the Food Service Admin Office located at 12913 Coldwater Rd.  Ft. Wayne, IN 46845  Attention:  Leeanne Koeneman

The USDA and the State of Indiana are equal opportunity providers and employers.

The USDA is an equal opportunity provider and employer.