Student Allergy Form

Student Allergy Form
Student Name*

First NameLast Name
Parent or Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Does your student have any known allergies?*

Yes, I have listed them below.No, my student has no known allergies.
In the box below, please list any and all allergies that your child may have. This must include food and medication. If your child has no known allergies, please indicate.
Known Allergies:
To the best of my knowledge, the above information is accurate and complete.*

YES
Parent or Guardian Signature*

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