If your child has severe food allergies or needs modified meals due to a medical condition, please complete the Special Diet Medical Statement Form. This form is required for all special diet modifications that are considered life threatening or substantially limits major life activities. Only a licensed physician, physician’s assistant, or nurse practitioner may sign the medical statement. This form MUST be kept on file for all students with disabilities receiving special diet modifications and allergies.
Please ensure that detailed diet information is provided on the medical statement stating the level of omission of the severe food allergen or foods that your child is intolerant to. This information is necessary to ensure your student is provided with the foods that are appropriate to their specific dietary restrictions. This information is necessary to ensure your student is provided with the foods that are appropriate to their specific dietary restrictions. For example, if your student cannot have eggs, we need to know if it is just whole eggs (i.e. scrambled eggs) or eggs cooked in products also (i.e. muffins).
For all other special diet requests, please see below.
| Additional Dietary Request Forms |