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Food Allergy Form

If your child has a disability or life-threatening food allergy as determined by a licensed physician and this prevents the child from eating regular school meals, we will make substitutions prescribed by the licensed physician at no extra charge for the meal.

For your child to receive a food substitution, you must have completed a Disability/Medical Condition Statement for Foods Served at School. The form is below for your convenience. Send the completed form to:

Nutrition Services
Learning Resource Center
3550 Mills Civic Parkway
West Des Moines, IA 50265

Special diet orders will be honored until and updated form is completed or a statement from the physician discontinuing the order has been received. It is no longer necessary to provide documentation on an annual basis.

Diet Modification Request