Special dietary needs will not be accommodated without a completed diet prescription form.
Children with Disabilities Requiring Special Meals
A person with a disability is one with a physical impairment or mental impairment that limits one or more major activities. Whenever a child is unable to eat or drink one or more of the required meal components, parents or guardians must submit to us a medical statement signed by a licensed physician.
A medical statement must identify the following:
1) The disability and an explanation of why the disability restricts the child's diet.
2) The major life activity affected by the disability.
3) The food or choice foods that must be omitted or substituted.
4) The physician's signature and contact information, should there be any questions.
Children with Special Dietary Needs
For participants with food allergies and food intolerances, we will make substitutions when supported by a statement signed by a recognized medical authority.
For non-disabled participants the supporting statement shall include:
1) An identification of the medical or other special dietary needs which restrict the child's diet.
2) The food or foods to be omitted from the participant's diet and the food or choice foods that may be substituted.
Send completed Medical Statements to your local School Nurse. Menus that meet the child's dietary prescription and/or texture modification will be developed.
USDA Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.
Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) Mail: U.S. Department of Agriculture
Office of the Assistant Secretary for Civil Rights
1400 Independence Avenue, SW
Washington, DC 20250-9410;
(2) Fax: (202) 690-7442; or
(3) Email: firstname.lastname@example.org.
This institution is an equal opportunity provider.