Glassford Hill
Middle School
FOOD ALLERGY PHYSICIAN S REQUEST FOR DIETARY ACCOMMODATIONS
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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 at6411 N Robert Road. Building 200. Prescott Valley AZ 86314or 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.
This institution is an equal opportunity provider Files: 1 Physician's Request for Dietary Modification 2022.pdf |