• Special Diets and Allergies


    If your child has allergies and requires a special diet or needs modified meals due to a medical condition, please complete the Medical Statement for Student’s Requiring Special Meals. This form is required before we can provide your student with anything other than the standard meal and also before we can omit/eliminate items from their meal. We cannot flag an account to warn the cashier of a medical condition until this form is on file in our office. For the protection of your student, it is therefore required that all meals should be supplied from home by packing a lunch until the form has been returned to the school health office. Only a licensed physician or physician’s representative may sign the medical statement. This form MUST be kept on file for all students with disabilities receiving special diet modifications and allergies. A short note from a physician on a prescription pad DOES NOT contain the required information and in addition a parent signature is required to provide alternate meals for your student. Required information includes:

    • The child’s disability or food allergy
    • An explanation of how the disability restricts the child’s diet
    • The food or foods to be omitted from the child’s diet and the food or choice of foods that need to be substituted.

    Please ensure that detailed diet information is provided on the medical statement stating the level of omission of the food allergen or foods that your child is intolerant to. This information is necessary to ensure your student is provided with the foods that are appropriate to their specific dietary restrictions. For example, if your student cannot have milk, we need to know if they cannot have milk to drink or if they cannot have any milk or dairy at all in their diet. Or, if they cannot have eggs, we need to know if it is just whole eggs (i.e. scrambled eggs) or eggs cooked in products also (i.e. cakes) Please complete the Medical Statement for Student’s Requiring Special Meals form and turn it in to your school health office. Feel free to contact  our Dietitian, Julie LaSerre at 816-736-6859 for more information or how we can better meet the special diet needs of your student. If your child’s diet changes for any reason, please make sure to have your physician fill out the Discontinuation of Diet form. It is the policy of the Liberty Public School Nutrition Department to follow any medical documentation that is on file in our office. We cannot make any changes or substitutions until the proper medical form is on file.


    If you have any questions, please call Julie LaSerre, RDN at 816-736-6859 or julie.laserre@lps53.org, LPSDietitian@lps53.org


Medical Statement

If you are having trouble viewing the document, you may download the document.

Discontinuation of Diet Form

If you are having trouble viewing the document, you may download the document.