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Allergy Assessment Form

  • All allergies requiring medication and/or special meal requirements must be documented by the child’s physician and you will need to provide us with a copy of that document.
  • Child's NameDate of BirthParent/GuardianPhone
  • 1. Food Allergy (Select Applicable Foods)

  • 2. Bee or Insect Allergy

  • 3. Asthma

  • (Please note that an allergy cannot be “removed” unless there is a note from the physician)
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

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