Healthy School Lunches - Dietary Requirements

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Kia ora everyone,
We are so lucky to be part of the Healthy School Lunches Programme which provides free lunches to all of our students. We are hoping to have the Healthy School Lunches Programme operating next term. All children will be given a lunch (unless you choose to opt out of the programme), however you will still need to supply brain snack and morning tea. At this stage our intended suppliers are Pita Pit, Subway and Libelle, although they are still to be confirmed. They will provide lunches on different days of the week and more details will be sent home when they are finalised.

It is really important that we gather the special dietary requirements of students. Even if your child does not have any dietary requirements, we still need for this form to be filled out for all students.

Please complete the form below for each child in your family. We would like it completed by Monday 22 March please.

Special dietary requirements come under the following categories and do not extend to food preferences, fussy eating, or non-medical aversions to particular foods:
• Ethical special diets (e.g. vegetarian, vegan)
• Religious special diets (e.g. halal meats, no pork, vegetarian)
• Allergies (e.g. peanut allergy, dairy allergy, gluten allergy) and additional information about severity of reaction
• Intolerances (e.g. lactose intolerance, gluten intolerance) and additional information about severity of reaction
• Other medically prescribed diets (e.g. liquid only or dysphagia diets for children at risk of aspiration, where food particles accidentally enter the lungs)

If you would like to discuss anything please contact Cheryl on 027 321 8022.

Email *

Child's Name (You will need to complete this survey for each child who attends Whitney Street School.) *

Room Number *

Opting in or out of the Healthy School Lunches Programme *

Yes please, I would like my child to participate in the Healthy School Lunches Programme

No thank you, I am choosing to opt out of the Healthy School Lunches Programme for my child and I will supply them with lunch

Required

My child has the following dietary requirements (Please tick all that apply). *

Not Applicable - my child has no dietary requirements

Not Applicable - I am opting out of the Healthy School Lunches Programme

Vegetarian (for ethical reasons)

Vegan (for ethical reasons)

Halal meals only (for religious reasons)

Pork free (for religious reasons)

Vegetarian (for religious reasons)

Peanut allergy

Dairy allergy

Dairy Intolerance

Gluten allergy

Gluten intolerance

Other medically prescribed diets (e.g. liquid only or dysphagia diets for children at risk of aspiration, where food particles accidentally enter the lungs)

Other allergy, intolerance or dietary requirement (please specify in the next question).

Required

Please provide more information, if needed, including other food allergies, and information about the severity of any allergies.

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