Allergy Form

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Allergy Form

Email *

Name of Child *

Year/Class *

Food Allergies *

Allergic to & medication prescribed

Natural/Seasonal Allergies *

Allergic to & medication prescribed

Animals *

Allergic to & medication prescribed

Medications *

Allergic to & medication prescribed

Other Allergies *

Allergic to & medication prescribed

Medication provided to the school *

Please click on link to give permission for school to administer medication provided https://forms.gle/eSY3tK3E8aTqbpzy8

Yes

Procedures to take if allergic reaction occurs *

Doctors Name, Address & Telephone Number *

Parent/Carer name & relationship to child *

The above information is, to the best of my knowledge, accurate at the time of writing. I will inform the school immediately, in writing, if there is any change in the medication or if the medicine is stopped.

A copy of your responses will be emailed to the address you provided.

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