Special Food Request Form

Food Service Medical Statement Form

When a Child Nutrition Program Director 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.

Forms do not need to be updated for students each year, but should reflect the current status of the child and should be updated to match current requirements for the child. The form must be signed by a physician.

Special Menu Request Form