Food Omission Form – St. Luke’s Academy

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Food Omission Form

St. Luke's Academy

FOOD CONSUMPTION/OMISSION FORM

TO BE COMPLETED BY PARENT/GUARDIAN

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Fields marked with an * are required

My Child/Ward *

First

Last

In Class *

Has no food sensitivies or food allergies and is permitted to consumes any food and/or beverage items brought to, or made on school grounds.

Choice 1

Please select and fill in appropriately below:

is not to consume any food items which are not brought to school in their respective lunch box.
is not to consume the following items listed below due to dietary limitation, allergies and or religious beliefs;

Paragraph Text

Mother/Female Guardian *

First

Last

Father/Male Guardian *

First

Last

Parent or Guardian Email *

Date *

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Whitehall
St. Peter
Barbados

office@stlukesacademy.com

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