EF5 – Medical and Meal Form EF5 – Medical and Meal Form SY 19-20 ALL students (new & returning) enrolling to The Children's Guild DC Public Charter School (TCGDC) must submit this form by April 30, 2019. If not completed after the deadline, your spot will be offered to the next family on the wait list. If you have any problems completing this form, please do not hesitate to contact The Children's Guild DC PCS front office at firstname.lastname@example.org or 202-774-5442. Student InformationNew or Returning Student*Is this student new or returning to TCGDC?New StudentReturning StudentGrade Level for the 2019-2020 school year. Please choose one.*KG1st2nd3rd4th5th6th7th8thStudent Name* First Name Middle Name Last Name List any medical conditions of which the school should be aware (i.e. diabetes; asthma; etc.):*If no medical conditions, type NAList any allergies and/or dietary restrictions for your child:*If no restrictions, type NAIs there any reason why your child should not take part in physical education or recess?*YesNoI understand that if my child has a life threatening medical condition or life threatening allergies I must submit paperwork and a life-saving medical device (epi-pen, inhaler, etc) before the first day of school. If I do not, I understand that my child may not attend school until I submit all necessities.*NO EXCEPTIONS will be made.Yes, I understand.No, I do not understand and will contact the school nurse for details.Meal InformationIf you plan to enroll in school breakfast or lunch, select the standard or special meal option.*Special meal details can be selected in the next section.Standard (includes dairy, chicken, beef, etc)Special Diet (vegetarian, gluten-free or dairy-free)My child will bring lunch from homeIf you selected the special meal option choose the dietary restrictions and/or preferences for your child(ren).Questions about meals can be sent to email@example.com. Vegetarian Gluten-Free Dairy Free I selected Standard. This section does not apply. Other Special Meal Option (Other)Please describe the dietary preferences.Signature, Date, and Certification of AccuracyI completed this form and I certify that the information above is accurate. I understand that providing false information for purposes of defrauding the government is punishable by law. Information provided on this form should be applied consistently throughout enrollment documentation.*Typed name acts as the signature of the Parent/Guardian with whom the student livesPerson Completing This Form Is:MotherFatherGuardianSubmission Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. For more information about EF5 – Medical and Meal Form please contact us.