Children With Allergies Form

This form is to be completed by the parent of a child with an allergy and returned to the nominated supervisor. The purpose of collecting this information is to identify children whose parents will need to provide further medical information, in order to provide a safe environment.

Allergens

Allergy signs and symptoms (PLEASE USE BLANK SPACES FOR ANY ADDITIONAL SIGNS)

Please select as many options as you need

If your child suffers from a severe food allergy, an individual management plan will be developed in consultation with you. This will include the collection of extensive information.

PLEASE ATTACH A LETTER FROM THE CHILD’S DOCTOR TO THIS FORM.

Please note: Prescription medicine will not be administered if labelled for anyone other than the child named on this form. Please ensure the medication (prescribed and over the counter) is clearly labeled with your child’s name, Date of Birth and dosage,  frequency required.

For more information refer to Medical Conditions Policy, Administration of Authorised Medication Policy  located in the foyer.


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