Allergy Form
2
Food/Environmental Allergy Notification ________My child has no known allergies Please make note of any known food and/or environmental allergies that your child may have: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ ___________________________________ If your child has any allergies please provide special instructions as to treatment of a reaction: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ ____________________
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Transcript of Allergy Form
Food/Environmental Allergy Notification
________My child has no known allergies
Please make note of any known food and/or environmental allergies that your child may have:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
If your child has any allergies please provide special instructions as to treatment of a reaction:____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
______________________________ Date________________(Signature of parent/guardian)
