FOOD ALLERGY PHYSICIAN S REQUEST FOR DIETARY ACCOMMODATIONS

If you wish to make any special dietary requests for your child, please print the Special Dietary Accommodations linked below. Have your State Licensed Healthcare Professional complete the form.

You may send completed forms to the Child Nutrition office at

6411 N Robert Road. Building 200. Prescott Valley AZ 86314

or Fax to 928-759-5025.

You may request an appeal if your child was denied diet modification by contacting the Section 504 Coordinator (school nurse.)

We offer a modified menu for our students that have a life-threatening food allergy or conditions that restricts the student’s diet.

Physicians Request for Dietary Modification form must be on file with school nutritionist before diet modifications are available to your child.

If you have any questions, please contact

Pamela Liuzzo, AS,NDTR,SNS at 928-759-5017 pamela.liuzzo@humboldtunified.com

7-12 Breakfast Allergen & Food Sensitivity List

7-12 Lunch Allergen & Food Sensitivity List

K-6 & LTS Breakfast Allergen & Food Sensitivity List

K-6 & LTS Lunch Allergen & Food Sensitivity List

This institution is an equal opportunity provider

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