FOOD ALLERGY AND MEDICAL CONDITION REQUEST FORM
Dear Parents and Guardians,
The United States Department of Agriculture (USDA) mandates that school meal programs must accommodate all students with disabilities, this includes food allergies and medical conditions.
In an effort to keep our students safe, our district follows a comprehensive food allergy and medical conditions protocol. In order to follow the USDA’s guidance and accommodate all students in the meal program, we need some information for students with documented food allergies and medical conditions to ensure we are providing a safe and nutritious meal.
Towards this end, I am requesting that you please complete and submit the following information for each student with a 504 plan or an MD note documenting a food allergy and/or medical conditions on the form:
· Full Name of Student
· Grade Level
· School Attended
· Documented Food Allergy(s) and Medical Conditions
· Foods and Ingredients to omit as a result of food allergy(s) and medical conditions
You can complete the form as part of your child's student handbook forms at the start of the school year. Alternately, if circumstances change during the school year, please request a print copy from the school and return it as soon as possible.
Linda Cahill RN MSN FNP
Director of Nurses