Student Allergy Form
It is of the utmost importance that our staff be aware of all student allergies, intolerances, religious & dietary restrictions. We will post (and update, as needed) a list of the students with their dietary restrictions in each classroom to ensure teachers, paraprofessionals, substitute teachers, etc are aware of allergies, intolerances and religious or other dietary restrictions.
Name of Student
*
First Name
Last Name
Please list all food allergies, intolerances, religious or dietary restrictions.
*
Name of Student
First Name
Last Name
Student Homeroom Classroom
Please list all food allergies, intolerances, religious or dietary restrictions.
Name of Student
First Name
Last Name
Student Homeroom Classroom
Please list all food allergies, intolerances, religious or dietary restrictions.
I am requesting my student (or students) name(s) with their dietary restrictions to be on a list in each classroom. Students eat in their classrooms, and other areas. This electronic signature is my permission for the above listed student's name(s), allergies, intolerances, religious and dietary restrictions to be displayed on a laminated list, on the wall in each classroom or areas that students may eat in.
Parent/Guardian Name completing this form
*
First Name
Last Name
Email
*
example@example.com
Submit
Should be Empty: