Creative Hands Early Childhood Institution

Child Special Dietary Needs Form

Creative Hands Early Childhood Institution
20 ½ Wayford Drive, Kingston 8
Email: creativehandsECI@gmail.com
Telephone: 1 (876) 531-5400
Website: creativehandseci.weebly.com
“Moulding small minds for a better tomorrow”

Name of child: ________________________________________________________________________

Age of child: __________________________________________________________________________

Date of enrollment: ____________________________________________________________________

Name of Parent/Guardian: _______________________________________________________________

Special Dietary Food Allergies Religious Food Intolerance

Needs Restrictions

Comments: ___________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Signature ________________________________________ Date ________________________________

Email: creativehandsECI@gmail.com
Telephone: 1 (876) 531-5400
Website: creativehandseci.weebly.com
“Moulding small minds for a better tomorrow”