Purpose of the Dietary Restrictions Form and Agreement
This form is used to provide important information about a child’s dietary restrictions, food allergies, or special dietary needs. It ensures that the school can accommodate the child's dietary requirements and take appropriate measures to ensure their safety during school meals and activities involving food.
Parent/Guardian Consent:
By signing this form, I, the undersigned parent or guardian of the above-named child, acknowledge and agree to the following:
- Responsibility for Information
I confirm that the information provided in this form is accurate and complete to the best of my knowledge. I agree to inform the school in writing of any changes to my child’s dietary restrictions or needs.
- School’s Role
I understand that the school will make every reasonable effort to accommodate my child’s dietary restrictions and ensure their safety during meals and activities involving food. However, I acknowledge that the school cannot guarantee that my child will not come into contact with restricted foods, particularly in public or shared areas.
- Emergency Procedures
I understand that in the event of a severe allergic reaction, the school will follow the emergency action plan provided in this form to the best of its ability and may seek emergency medical assistance as needed.
- Release of Liability
I release the school, its employees, and representatives from any liability or claims in the event that my child comes into contact with restricted foods despite reasonable efforts by the school to prevent such occurrences.
- Automatic Consent in Absence of Form
I understand that if this form is not completed and returned, the school will assume that my child does not have any dietary restrictions or allergies.
- Questions and Clarifications
Any questions or concerns regarding the school’s dietary policies or procedures can be directed to the Main Office at:
Address
Email
Phone Number
