SAISD Child Nutrition Special Diet Request Form 2023-2024-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Part 1, where the Parent/Guardian should enter today's date, the student's name, date of birth, school name, grade, and student ID number.
3. Indicate which meals the student will be eating from the cafeteria by circling all applicable options: Breakfast, Lunch, or None. Provide a good email contact for further communication.
4. In Part 2, ensure that a Licensed Medical Authority completes the necessary sections regarding any severe food allergies or medical conditions. They must specify affected life activities if applicable.
5. List any food allergies and suggested substitutions for items not served. This includes common allergens like dairy, wheat/gluten, peanuts, and others as specified in the form.
6. Finally, have the Medical Authority sign and date the form along with their office phone number before submitting it to the designated contact.

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