Edible Treat Request Form

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Thank you for utilizing our new online forms library to submit electronic requests for approval. This Edible Treat Request Form will assist you in organizing all of the information necessary to be approved to bring in an edible treat. Please keep in mind that the District encourages non-edible treats to reinforce a healthy lifestyle, which does not include food as a reward, and instead emphasizes the importance of intrinsic motivation and uses social learning experiences as rewards. The information below will be reviewed by both the School Nurse and Principal. Once a decision is made, you will be contacted. Should you have additional questions, you may contact the front office or the nurse's office to follow up. Thank you again for utilizing our online forms! It is greatly appreciated!

1.	Please enter your name as the contact person for this request in the space provided below.* This information will be utilized to contact you in the event of a question and to correspond regarding whether or not the edible treat is approved.

2.	Please enter your email address for use in correspondence.*

3.	Please enter the date, on which you would like to bring the edible treat into the school. Please note that dates, which are not submitted according to the timelines below will not be approved due to the need to review student allergies and health needs, as well as ingredients.* If the treat is for one classroom, please submit at least 48 hours prior to the activity. If the treat is for an entire grade level or the entire school, please submit at least two weeks prior to the activity.
	mm/dd/yyyy

Please select the group for whom the edible treat will be. In addition, if you select a single classroom, please indicate your child's name, as well as their class section in the final text field.*

An entire grade level

The entire school

A group of students involved in a school club or activity

One classroom, please specify the specific classroom section (i.e. 5A) and your child's name here.

Noting that the school will only approve healthy items, such as whole grain snacks or fruits/vegetables, which meet the wellness policy, and that the school strongly prefers to utilize non-edible treats unless having an edible item contributes to the curriculum or a cultural understanding, please select the appropriate boxes below which explain how bringing this edible treat will benefit the students without violating the health and wellness policy.*
Select at least 1.

To reinforce a cultural concept being discussed in class

To utilize as a manipulative in demonstrating a concept (lab, etc)

To serve as an alternate healthy lunch for a student group

Select the box or boxes next to the appropriate edible items, which you would like to bring in for the event if approved.*
Select at least 1.

Fresh Fruit

Vegetables

Low Fat/Low Sugar Yogurt

Pretzels or Other Whole Grain/Low Fat/Low Sugar Item

Other, please specify

7.	Please enter the name of the edible treat, including a specific list of ingredients including brand names of each ingredient.* After the treat has been approved according to our wellness policy, the nurses will then check the ingredients against the medical needs of the students enjoying the treat. We will respond to you via email and/or phone. In some cases, we will need to see the packaging as well for additional information. Thank you!