We accommodate disabilities as defined by the government. According to the USDA, a disability is "a physical or mental impairment that significantly limits one or more of an individual's major life activities."

Special Diet Form

We acknowledge the following as disabilities

• Food Allergies:
  • "Big 9" (wheat, soy, milk, eggs, sesame, peanuts, tree nuts, fish, shellfish)
  • Other less common allergens
• Medical Conditions:
  • Lactose Intolerance
  • Celiac's Disease
  • Diabetes Mellitus
  • G6PD
  • Other medical conditions that affect dietary needs

If your child has a disability that affects their diet, we invite you to fill out the correct form on this page and return it to us as soon as possible.

This form is for newly diagnosed allergies or allergies that you would like us to add to our system. This form is also for changing allergy management instructions.

Special Diet Form

Directions: Parents/guardians must fill out the top box and a Licensed Physician, Physician's Assistant, or Registered Nurse Practitioner must fill out the bottom box. Have the medical provider submit the completed form to the email or fax listed on the bottom of the form.

Parents/Guardians: While you are in the process of getting the Special Diet Form filled out and submitted to us, please pack all your child's meals and snacks. Please continue to pack your child's meals while our Registered Dietitian builds a modified menu for your child. This is necessary, as we need time to review food labels for your child's safety and to order special products if needed. The Registered Dietitian will reach out to you as soon as the modified menu is built for you to review and approve, and will specify a menu start date. 

This form is for incorrect or outgrown allergies or allergies that you would like us to remove from our system. This form is NOT for changing allergy management instructions. If you would like to keep an allergy in our system but change how we manage it, please refer to the Special Diet Form, above.

Allergy Removal Form

Directions: Parents/guardians must fill out the entire form and submit it to the Registered Dietitian (RD). This can be done by emailing the completed form directly to the RD or handing the form to a Chartwells employee in the cafeteria. A doctor's signature is not required for this form.

Note to Parents/Guardians: We must follow the doctor's instructions until we have new documentation of your child's allergies or medical conditions. Once we receive the completed Allergy Removal Form, we are able to remove the requested allergies from our system and start serving your child according to the new information on the same-day.

Food Allergy Management Policy                                           2023 Letter on Food Substitutions

Coming soon.

For questions about accommodations, please contact:

Monique Mazaika, RDN she/her/hers

Email: mmazaika@pmsd.org

Phone: (570)839-7121 x80455