COOPERATIVA MENSA della SCUOLA EUROPEA di VARESE
COOPERATIVA MENSA della SCUOLA EUROPEA di VARESE
Form to request a special diet 2022/2023
* Required fields
Surname member
*
Name member
*
e-mail address
*
Don't send a copy of the application to this email
Lastname and firstname of the student
*
Section
*
Ins.Mat.
Ins.Pri.
Ins.Sec.
Materna
P1
P2
P3
P4
P5
S1
S2
S3
S4
S5
S6
S7
Class
DE
EN
FB
IT
NB
wishes to inform that the pupil above needs a special diet:
1) NATURE OF DIET
*
with medical certificate
(required field for gluten free diet)
i enclose a recent medical certificate
medical certificate date
/
DD
/
MM
YYYY
the medical certificate of last year is still valid because the situation has not changed.
for ethical or religious reason.
Diet without (please specify):
2) NATURE OF SERVICE
PUPILS of kindergarten (Mat, P1, P2)
*
I request that the proscribed dishes are replaced by other dishes served on the same day (the Board of Directors will decide if an extra payment is due)
I request a gluten free meal*
2.b Self Service (P3, P4, P5, S1, S2, S3, S4, S5, S6, S7, INS. MAT., INS. PRI., INS. SEC.)
the pupil can choose for him/herself. Only to consider in the case of a picnic prepared by the COMSEV
I request a gluten free meal*
I agree that my son/daughter chooses the dessert
I DON’T agree that my son/daughter chooses the dessert
I request a special service (to be agreed with the office)
To prepare on the following days:
MONDAY
TUESDAY
THURSDAY
FRIDAY
NOTICE
I declare that I have read the communication concerning prices for the current year.
*
In the event that we cannot accommodate the special diet required you will be contacted by the COMSEV office.
In the case of absence I have to contact COMSEV office by 08.30 AM by phone or e-mail, otherwise the meal and the extra fee will be charged.
All requests will be forwarded to the Rojac company which takes care of the preparation of the meals.
CONSENT for the PRIVACY: I consent
to the processing, communication and dissemination of
sensitive
personal data of my son /daughter, within the limits indicated in the information notice on the website.
