Special Dietary Needs Forms
In order for Nutrition Services to properly accommodate your students special dietary needs in the National School Lunch and Breakfast Program, we must have one of the following forms on file. If you are visiting your physician, please provide them this form to complete. We cannot accept doctors notes, allergy testing forms, diet orders, etc.If a child's IHP plan includes the information required in the medical statement, it is not necessary to submit a separate medical. statement. If an IHP contains insufficient allergy information, additional may be requested to properly accommodate the student.
Pacific Ultra Soy Milk is available to all K-12 students daily without a request.
If your child attends the Early Learning Center:
Please have the Request for Special Dietary Accommodation form filled out by your Recognized Medical Authority and turned into the Nutrition Services office. If your child needs just a milk substitution, a parent or guardian and complete the Milk Substitution Form. If your child has a life-threatening allergy, please contact your school to develop an individual health plan.
If your child is in grade K-12-
Please fill out the Special Dietary Accommodations form signed by the recognized medical authority and turned into the Nutrition Services office.
If your child has a life-threatening allergy, please contact your school to develop an individual health plan.
*Special accommodations may not be made until form is filled out correctly and completely*.
Recognized Medical Authorities Include: Physicians (MD) , Physicians Assistants (PA-C), ARNP, Doctor of Osteopath, and Naturopathic Physicians (ND).
Does not include: Registered Dietitians, nurses without ability to prescribe medicine, and naturopaths without ND credentials
Mail forms to:
7205 E Mission Ave
Or, turn into your schools front office or school nurse.