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This form is used to request food substitutions for children in the Child and Youth Services program who have dietary restrictions due to medical or religious reasons. It outlines the necessary information
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How to fill out CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT

01
Begin by obtaining the CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT form.
02
Fill in the child's name and date of birth at the top of the form.
03
Provide details about the child's dietary needs, including specific allergies, intolerances, or medical conditions.
04
Include information about the types of special diets required (e.g., vegetarian, gluten-free).
05
If applicable, request a healthcare professional's signature or verification to support the dietary needs.
06
Review the completed form for accuracy and completeness.
07
Submit the form to the appropriate child and youth services provider or institution.

Who needs CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT?

01
Children and youth with specific dietary restrictions due to medical conditions, allergies, or other health-related issues.
02
Parents or guardians of children requiring special dietary accommodations.
03
Childcare facilities and educational institutions that serve food to children with special dietary needs.
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What are the common special dietary requirements? Gluten free and coeliac. Dairy free and lactose free. Vegetarian. Vegan. Paleo. FODMAP. Tree nut and peanut allergies. Fish and shellfish allergies.
Focusing on nutrient-dense foods helps kids get the nutrients they need while limiting overall calories. Consider these nutrient-dense foods: Protein. Choose seafood, lean meat and poultry, eggs, beans, peas, soy products, and unsalted nuts and seeds.
What Are the Most Common Dietary Restrictions? Vegetarian and Vegan. Being vegan and vegetarian are usually mentioned in the same category of dietary restrictions, but one is significantly more restrictive than the other. Lactose Intolerance. Gluten Intolerance. Peanut Allergies. Religious Food Restrictions.
By having an idea of the balance in your diet, it should be easier to enjoy food and be healthy. There are seven essential factors for a balanced diet: carbs, protein, , fibre, vitamins, minerals and water.
The phrase "special diet" is a term used by medical and nutrition professionals to indicate the type of foods or nutrients that someone should add or eliminate to their diet to help them heal, recover, or feel better.
The licensed medical practitioner's statement must identify: • an explanation of how the child's physical or mental impairment restricts the child's diet; • the food(s) to be avoided; and • the food or choice of foods that must be substituted.
Enjoy a wide variety of nutritious foods from the 5 food groups (vegetables, fruit, grains/cereals, meat/alternatives and dairy/alternatives) every day.
Reduce your intake of sweetened drinks, sweets and sugar. Use salt and foods high in salt sparingly – avoid adding salt to your food at the table. Reduce the amount of salt you add when cooking. Use herbs and lemon to flavour your food.

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The CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT is a form used to document specific dietary requirements of children and youth in care to ensure they receive appropriate nutrition based on their individual needs.
Organizations and facilities that provide care for children and youth, such as daycares, group homes, and residential services, are required to file the CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT for each child with specific dietary needs.
To fill out the CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT, caregivers should provide detailed information about the child's dietary restrictions, allergies, cultural or religious dietary practices, and any other relevant nutritional needs.
The purpose of the CHILD AND YOUTH SERVICES SPECIAL DIET STATEMENT is to ensure that all children and youth in care receive dietary accommodations that cater to their health and well-being, facilitating their proper growth and development.
The information that must be reported includes the child's name, age, specific dietary restrictions, allergens, any special dietary practices related to health, culture, or religion, and the name of the person completing the statement.
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special diet Child and Youth Services food substitutions CACFP nutritional requirements religious food preference medical dietary restrictions food allergy photo release consent parent guardian information

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