Chilton, WI 53014
Health
Mrs. Katie Breitlow
RN BSN
breitlowk@cpsdwi.onmicrosoft.com
(920) 849-9457 or ext. 2209
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Jul142016

Dietary Restriction Letter to Parents

Information
First published on 14 July 2016 Posted in Health

Dear Parent or Guardian,

If your child needs meal or snack accommodations while at school from food services due to an allergy, celiac disease, gluten intolerance, lactose intolerance or another condition, a Dietary Request Form must be completed and signed by your child’s health care provider. Once complete, please return to your school office.

It is important that you notify your school nurse and your child’s healthcare provider if there are any changes during the school year for our records. Please feel free to call us if you would like to discuss your child’s condition or need help completing this form. Thank you for your time.

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