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Get IN Carmel Clay Schools Special Dietary Needs Form 2018-2024

Will be made when the accommodation requested is due to a disability or impairment. If you are requesting a meal accommodation or substitution for your student, please complete and sign this form. A physician note or statement may be required if the meal accommodations cannot be met with regularly served menu items. PARENT/GUARDIAN Student Name Date of Birth Name of Parent/Guardian Grade Level/Classroom Name of School/Site Phone Number of Parent/Guardian Please provide an explanation be.

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