Fillable SICK TRAY DINING REQUEST FORM (University of North Dakota)

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SICK TRAY DINING REQUEST FORM (University of North Dakota)

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SICK TRAY DINING REQUEST FORM
Today’s Date _______________________
Name ________________________________ Student ID # _____________________
Hall ________________ Room #________
Name of Person Picking Up Tray ___________________________________________
Select One:
____ Traditional Sick Tray
Choose a meal from daily menu. (1 meal swipe)
____ Flu-Fighter Kit 1
(mostly liquids)
Kit 1 (enough for 2 meals = 2 meal swipes) - for the first 24-48 hours of flu-like symptoms:
• 2 Cans of Campbell’s Soup
• 1 Pkg. Oatmeal
• 2 Pkg. Saltine Crackers
• 2 Hot Tea Bags
• 1 Nutrigrain Bar
• 3 Sugar Packets
• 1 Can of Sprite
• 1 Powerade
• 3 Apple Juices
• 3 - 10 oz. Bottled Waters
• Utensils, napkins, paper hot cups, disposable bowl
____ Flu-Fighter Kit 2
(liquids and more solids)
Kit 2 (enough for 2 meals = 2 meal swipes) - for the 3rd- 4th day, after fever subsides:
• 2 Cans of Campbell's Soup
• 1 Pkg. Oatmeal
• 2 Pkg. Saltine Crackers
• 1 Banana
• 2 Slices Bread
• 4 Packets Peanut Butter
• 4 Packets Jelly
• 1 Nutrigrain Bar
• 2 Hot Tea Bags
• 3 Sugar Packets
• 1 Chocolate Pudding Cup
• 1 Powerade
• 3 Apple Juices
• 3 – 10 oz. Bottled Waters
• Utensils, napkins, paper hot cups, disposable bowl
Remember: The person picking up the meal will need to present their ID card for verification
purposes.
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SICK TRAY DINING REQUEST FORM (University of North Dakota)

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Completed 30 August 2020

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