CHILD AND ADULT CARE FOOD PROGRAM MENU FORM
DAY CARE HOME
         KEEP ON FILE 
DATE September 2009      PROVIDER'S NAME Kimberly Ussery                IN THE HOME
CALENDAR DATE   1 2 3 4
BREAKFAST fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk Child over 11 mo's
fruit, vegetable or full strength juice peaches applesauce 100% orange juice tomatoes bananas Infant 8-11 mo's
cereal and/or bread equivalent   oatmeal waffles cheerios grits pancakes Infant 4-7 mo's
 + additional food (optional)       yogurt     Infant 0-3 mo's
   AM SNACK Choose two of these four:
 
          Special Menu
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent            
meat and/or alternate  
          LUNCH fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
meat and/or equivalent   turkey macaroni & cheese fish sticks chicken taquitos beef stew
vegetable or fruit   corn peas beets green beans carrots
vegetable or fruit   mixed fruit pears mandarin oranges pineapple applesauce
bread or equivalent   roll macaroni hushpuppies corn tortilla rice
 + additional food (optional)            
    PM SNACK Choose two of these four.*
100% apple juice fluid milk 100% grape juice fluid milk 100% white grape juice
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent   rice cakes bananas peanut butter sandwich apple slices vanilla wafers
meat and/or alternate  
       SUPPER fluid milk              
meat and/or alternate            
vegetable or fruit              
vegetable or fruit            
bread or equivalent            
 + additional food (optional)            
DE FORM 0863, Revised April 1990       *Juice cannot be served when milk is served as the only other component. Enriched Bread  100% Juice  HM=Home Made
CHILD AND ADULT CARE FOOD PROGRAM MENU FORM
DAY CARE HOME
         KEEP ON FILE 
DATE September 2009      PROVIDER'S NAME Kimberly Ussery                  IN THE HOME
CALENDAR DATE 7 8 9 10 11
BREAKFAST fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
fruit, vegetable or full strength juice applesauce apricots banana peaches mixed fruit
cereal and/or bread equivalent   waffles biscuit french toast oatmeal bagel
 + additional food (optional)     eggs      
   AM SNACK Choose two of these four:
 
         
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent            
meat and/or alternate  
          LUNCH fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
meat and/or equivalent   chicken nuggets chesse roll-ups turkey tuna casserole beef hamburger
vegetable or fruit   white beans carrots beets peas corn
vegetable or fruit   peaches bananas pears mandarin oranges pineapple
bread or equivalent   corn bread crescent roll whole wheat bread pasta bun
 + additional food (optional)            
    PM SNACK Choose two of these four.*
100% mixed fruit juice fluid milk 100% apple juice fluid milk 100% grape juice
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent   cheese toast cheerios graham crackers apple slices oatmeal cookie
meat and/or alternate  
       SUPPER fluid milk              
meat and/or alternate            
vegetable or fruit              
vegetable or fruit            
bread or equivalent            
 + additional food (optional)            
DE FORM 0863, Revised April 1990       *Juice cannot be served when milk is served as the only other component. Enriched Bread  100% Juice  HM=Home Made
CHILD AND ADULT CARE FOOD PROGRAM MENU FORM
DAY CARE HOME
         KEEP ON FILE 
DATE September 2009      PROVIDER'S NAME Kimberly Ussery                  IN THE HOME
CALENDAR DATE 14 15 16 17 18
BREAKFAST fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
fruit, vegetable or full strength juice tomatoes bananas mixed fruit applesauce peaches
cereal and/or bread equivalent   grits pancakes cheerios waffles oatmeal
 + additional food (optional)            
   AM SNACK Choose two of these four:
 
         
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent            
meat and/or alternate  
          LUNCH fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
meat and/or equivalent   peanut butter sandwich ham macaroni & cheese hamburger pizza fish sticks
vegetable or fruit   vegetable beef soup green beans carrots corn broccoli
vegetable or fruit   peaches pineapple pears mandarin oranges banana
bread or equivalent   whole wheat bread roll macaroni pizza crust hushpuppies
 + additional food (optional)            
    PM SNACK Choose two of these four.*
100% white grape juice fluid milk 100% mixed fruit juice fluid milk 100% apple juice
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent   rice cakes apple slices graham crackers craisins sugar cookies
meat and/or alternate  
       SUPPER fluid milk              
meat and/or alternate            
vegetable or fruit              
vegetable or fruit              
bread or equivalent            
 + additional food (optional)            
DE FORM 0863, Revised April 1990       *Juice cannot be served when milk is served as the only other component. Enriched Bread  100% Juice  HM=Home Made
CHILD AND ADULT CARE FOOD PROGRAM MENU FORM
DAY CARE HOME
         KEEP ON FILE 
DATE September 2009      PROVIDER'S NAME Kimberly Ussery                  IN THE HOME
CALENDAR DATE 21 22 23 24 25
BREAKFAST fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
fruit, vegetable or full strength juice bananas 100% orange juice peaches applesauce pears
cereal and/or bread equivalent   pancakes cheerios oatmeal waffles bagel
 + additional food (optional)           yogurt
   AM SNACK Choose two of these four:
 
         
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent            
meat and/or alternate  
          LUNCH fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
meat and/or equivalent     chicken strips cheese toast fish filet meatsauce lasagna turkey
vegetable or fruit   lima beans carrots green beans corn peas
vegetable or fruit   pears applesauce pineapple mixed fruit peaches
bread or equivalent   biscuits whole wheat bread cornbread pasta roll
 + additional food (optional)            
    PM SNACK Choose two of these four.*
100% grape juice fluid milk 100% apple juice fluid milk 100% mixed fruit juice
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent   cinnamon toast bananas graham crackers peanut butter sandwich fig newtons
meat and/or alternate  
       SUPPER fluid milk              
meat and/or alternate            
vegetable or fruit              
vegetable or fruit            
bread or equivalent            
 + additional food (optional)            
DE FORM 0863, Revised April 1990       *Juice cannot be served when milk is served as the only other component. Enriched Bread  100% Juice  HM=Home Made
CHILD AND ADULT CARE FOOD PROGRAM MENU FORM
DAY CARE HOME
         KEEP ON FILE 
DATE September 2009      PROVIDER'S NAME Kimberly Ussery                  IN THE HOME
CALENDAR DATE 28 29 30    
BREAKFAST fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
fruit, vegetable or full strength juice peaches applesauce 100% orange juice tomatoes bananas
cereal and/or bread equivalent   oatmeal waffles cheerios grits french toast
 + additional food (optional)            
   AM SNACK Choose two of these four:
 
         
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent            
meat and/or alternate  
          LUNCH fluid milk     fluid milk fluid milk fluid milk fluid milk fluid milk
meat and/or equivalent   ham macaroni & cheese chicken taquitos meatloaf beef stroganoff
vegetable or fruit   carrots green beans corn beets peas
vegetable or fruit   bananas pears mandarin oranges mixed fruit pineapple
bread or equivalent   crescent roll macaroni corn tortilla whole wheat bread pasta
 + additional food (optional)            
    PM SNACK Choose two of these four.*
100% orange juice fluid milk 100% apple juice fluid milk 100% white grape juice
fluid milk    
fruit, vegetable or full strength juice                    
bread, cereal or equivalent   sugar cookie apple slices goldfish crackers bananas graham cracker
meat and/or alternate  
       SUPPER fluid milk              
meat and/or alternate            
vegetable or fruit              
vegetable or fruit            
bread or equivalent            
 + additional food (optional)            
DE FORM 0863, Revised April 1990       *Juice cannot be served when milk is served as the only other component. Enriched Bread  100% Juice  HM=Home Made