North Clackamas Schools

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Simply Good



Allergy / Special Diet Menu Requests

Federal regulations require Child Nutrition Programs Sponsors to offer to all participants' breakfasts, lunches, suppers, snacks, and milk that meet the meal requirements identified in the individual program regulations.  Federal regulations further require Sponsors to make substitutions to the standard meal requirements for participants who are considered disabled and whose disability restricts their diet. 

The following forms can be found on the ODE website, see link below: 

  1. Medical Participants with Disabilities Form (ODE Website Link

  2. Medical Participants without Disabilities Form (ODE Website Link

    Part I: Write your child's name

    Part II: This section can only be completed by your child's physician

    Every section must be completed: 

  • Diagnosis 
  • Does the disability restrict the patient's diet? Yes or No
  • If Yes, list how
  • Foods to be omitted from diet
  • Foods to be substituted
  3. Milk Substitution Form - can be completed by parent/guardian: (ODE Website Link

    Part I: Write your child's name

    Part II: Complete sections:

  • Medical or other dietary need for substitution
  • Print your name, sign and date



Last Modified on February 20, 2017