Food Service Medical Statement Forms

When a food service manager is asked to make a menu substitution for a student due to allergies or other special dietary needs, it is the responsibility of the parent/guardian to submit a properly filled out and documented medical statement form.

Two forms are available when special food substitutions are requested, one for students with a disability and one for students without a disability. The form must be signed by a physician.

Parents should return the completed and signed form to the school office. A new form must be submitted every year.

Form for students with a disability

Form for students without a disability