Diet Modification 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. Special diet orders will be honored until an 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. Send the completed form to:
Nutrition Services
Learning Resource Center
3550 Mills Civic Parkway
West Des Moines, IA 50265