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Special Dietary Needs

If your child participates in the school breakfast or lunch program and has a special dietary need, please use this form to make a request for special food items. The form needs to be signed by a state-recognized medical authority.

Please return completed forms to your school nurse. They will forward the information and any special instructions to the Child Nutrition Department. 

If you have questions regarding this form, please contact the Child Nutrition Office at 253-891-6450.

Request for Special Dietary Accommodations Form