Diet Modification Form

In some situations, students require a special diet. No special diets or substitutions will be made unless this form is properly completed and approved by the Nurse and Food & Nutrition Director. If your child requires a diet modification, have your child's physician fill out a Diet Modification Request for Foods Served through Child Nutrition Programs form. The completed form should be returned to your school nurse and then is forwarded to the Food & Nutrition Office.
Federal regulations governing Child Nutrition Programs provide that schools must make substitutions in meals for students who are considered to have a disability as defined by the Americans with Disability Act and whose disability restricts their diet when supported by a statement signed by a physician licensed by the state
By regulation, juice can no longer be substituted for milk. Soy milk with a regular breakfast or lunch is available to those with dairy intolerances/allergies who have submitted a Diet Modification request form.