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District Nurse

Chilton Public Schools Logo

Katie Breitlow, RN BSN

530 W Main Street
Chilton, WI 53014
Tel #: (920) 849-9457 ext. 2209

Dietary Restriction Letter to Parents

Jul142016

Dietary Restriction Letter to Parents

 

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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