Sick Tray Form

If you are not feeling well, you can request that a friend be allowed to pick up a sick tray for you to take back to your room. To do so, print and complete this form. The form then must be presented to a Chartwells manager at Vandenberg Dining Center or the Pioneer Food Court. This form is valid for one-day usage only.

I    authorize  , 
(your name) (friend's name) (student number)

to pick up a sick tray for me on   .
(date)


My meal ticket number


My room/hall/phone number: 


I need:    breakfast    lunch     dinner


Student Signature: _________________________________

Residence Halls Staff Signature: _______________________________