Allergy Notification Form

Lets parents and guardians tell the school about a student's food allergies and what to do if a reaction occurs.

Use this template

Student's Name

Nombre

Apellido

Student's Phone Number

Does your child have any food allergies or intolerances?

Yes No

Please specify.

If you checked any of the boxes above, please share more details about the nature of the allergy/intolerance:

Does your child carry an EpiPen or autoinjector?

Yes No

Name of Parent/Guardian

Nombre

Apellido

Parent/Guardian Phone Number

Date

Signature

Sign here

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