Edible Treat Request
Return this portion to the classroom teacher
THIS FORM MUST BE SUBMITTED AT LEAST 48 HOURS PRIOR TO THE DATE OF THE TREAT
Student Name ____________________________________Homeroom/section ______
Telephone number(s): ____________________________________________________
Date of Request: ____________________________________
Date of Treat: ______________________________________
List of ingredients: ________________________________________________________________________
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Parents will only be contacted if there is a problem with the snack ( i.e. contains a food ingredient not permitted in the class due to allergy) to let them know that the proposed snack/treat is not allowed to be distributed to the class.
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FOR SCHOOL USE ONLY
_____ Approved by Nurse –and returned to teacher on _________ _____Not approved by Nurse – parent contacted on ___________
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