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 firstname.lastname@example.org
This institution is an equal opportunity provider
- 1 Physician's Request for Dietary Modification 2022.pdf
- December CSES, GES, HES, LTS Gluten Free
- December MVES, LVES Gluten Free
- December No milk to drink, No cheese, No whole egg, No gluten. Give almond milk
- January CSES, GES, HES, LTS Gluten Free
- January MVES, LVES Gluten Free
- January No milk to drink, No cheese, No whole egg, No gluten. Give almond milk