Breakfast/Lunch Menu

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Nespelem School District 

Special Dietary Needs Procedure 

1. At the start of each school year the Nespelem School District will notify all families of the 

availability of special dietary accommodations in their back to school packet. This notice will include the procedure for requesting an accommodation through the school secretary.  

2. Any reports of a child with a food allergy or other impairment that affects their diet must be reported to the school nurse.

3. If the school nurse is informed of a special dietary need, or if a parent submits a Health History form identifying a food allergy or any other impairment that may affect their child’s diet, the nurse will notify the family that in order to facilitate the special dietary need, the school must receive a completed Special Dietary Needs Form signed by a recognized medical authority. Families will also be informed of the offer vs serve policy in school meals for children without a medical impairment.  

4. If families would like to have a special dietary accommodation for their child, the nurse, or the office will send them a copy of the Special Dietary Needs Request Form.  

5. If the district is aware a meal modification is needed, our district will not delay providing the modification while awaiting the medical statement.  Instead, Mary Walker School District will begin providing a reasonable modification to keep the child safe, and request the family provide a medical statement signed by a State Recognized Medical Authority to support the meal modification as soon as possible.

6. Kitchen staff, including cashiers, will be informed of the new accommodation and either introduced to the child or given a copy of the child’s picture. The special dietary accommodation will also be entered into Skyward as a message that will appear at the Point of Sale.  

7. If the family does not return the form within 30 days, the school will determine on a case by case basis if the dietary need will be accommodated while continuing to attempt to contact the family.  

8. If a family returns an incomplete form, the family is notified that more information is needed and is given 60 days to return a completed form.  The child’s special dietary need is accommodated during that time. If the completed form is not returned after 60 days, the family is notified that the child’s dietary needs may not be accommodated until a completed form is received by the school.  

9. All Special Dietary Accommodation Forms will be kept with the school nurse. Copies are made and shared with all staff in cafeteria and kept in a binder at the point of sale.  

5 Special Dietary Needs Checklist for Internal Use Only 

Child’s Name: _____________________________________ 

 Family has been notified of the Special Dietary Needs Request Form.  

 Family has been notified of Offer vs Serve in school meal service.  

 Special Dietary Needs Request Form has been sent to the family. 

o Date __________________________  

A. 

 Completed Special Dietary Needs Request Form has been returned by the family.  

o Date __________________________ 

 The student’s new diet is accommodated immediately 

 All Lunchroom staff are notified of new special diet and provided with all information of Special 

Dietary Needs Request form.  

 Special diet information is entered onto Skyward.  

 Completed Special Dietary Forms are stored ___________ (location) 

Or B.  

 Incomplete Special Dietary Needs Request Form has been returned by the family.  

 The student’s new diet is accommodated immediately 

 All Lunchroom staff are notified of new special diet and provided with all information of Special 

Dietary Needs Request form.  

 The family has been informed that more information is needed and given 60 days to return the 

completed form.  

o Date __________________________   

 The family has not returned the form after 60 days  

o Date __________________________ 

 The family is notified that the special diet will be discontinued until a completed form is 

received.  

 The Child’s special diet has been discontinued 

o Date __________________________

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