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Medical Dietary Order Form

To comply with law regarding the equal rights and opportunities act Section 504 of the Rehabilitation Act of 1973.


  1. Parent must obtain the Special Diet Form and have it signed by the child’s physician.
  2. Dietary restrictions, orders, or other needs regarding meals prepared at school will be ordered by the physician, acknowledged by the Dietary Supervisor, and prepared daily.
  3. Please ask parent to notify the school if the child will be absent.

Special Dietary Form