LOUISIANA CHILD AND ADULT CARE FOOD PROGRAM DAILY MENU WORKSHEET RECORD: ADULT DAY CARE
CACFP- 6 Rev 10/17 (Updated 10/2021)
SPONSOR: _______________________________________________________ FACILITY: _______________________________________________________ DATE: ___________________________________
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MEAL PATTERN
MENU
SERVING SIZE
NO. TO BE SERVED
FOOD ITEMS USED
AMOUNTS USED
NUMBER SERVED
BREAKFAST 1. *MILK 2. ** GRAIN / BREAD (2) 3. FRUIT OR VEGETABLE 4. OTHER (OPTIONAL) ***Meat or meat alternate may be served in place of entire grain component at breakfast a maximum of 3 times per week.
Reg Diets _________ Spec Diets _________ Adults
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TOTAL _________
LUNCH Reg Diets _________ 1. *MILK 2. ** GRAIN / BREAD (2) 3. MEAT OR MEAT ALTERNATE 4. VEGETABLE 5. VEGETABLE OR FRUIT
Spec Diets _________ Adults
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TOTAL _________
P.M. SNACK (CHOOSE 2) Reg Diets _________ 1. *MILK 2. ** GRAIN / BREAD 3. FRUIT 4. VEGETABLE 5. MEAT OR MEAT ALTERNATE
Spec Diets _________ Adults
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TOTAL _________
*Yogurt may be served in place of milk one time per day for adults only. Yogurt must contain no more than 23 grams of sugar per 6oz.