Special Diet Accommodation Form
Help us provide the right dietary support for your child
Student's Full Name
*
First Name
Last Name
School / Campus
*
Grade
*
Is this dietary need due to a food allergy or religious reason?
*
Food Allergy
Religious Reason
Other
Do you have a special diet form completed by a doctor?
*
Yes
No
Upload completed special diet form (if available)
Upload a File
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Choose a file
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of
List all foods/ingredients the student cannot have
*
Please suggest adequate replacements for restricted foods (if available)
Submit Request
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