Health and Safety Allergy Plan

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In order to promote a safe and fun environment, we hope parents can fill out this form to help WSCLC create a Health and Safety Allergy Plan. This plan is meant to help staff and teachers get a better understanding of students' allergies as well as respond appropriately in the case of an allergic reaction. We hope to provide a safe environment for students.

*If you have more than one child, please fill out a separate form for each student.
*There is no need to fill out the form if your child does not have allergies.
*All information submitted will be kept confidential in accordance to the law.

Thank you for taking the extra steps to make our school a safer place.

Student Name (please provide both Chinese and English name) *

Student Grade *

Allergies (please list what your child is allergic to) *

Symptoms (please list the symptoms of an allergic reaction so teachers and staff can know what to pay attention to)

Response Plan (please write down how you want staff and teachers to respond in the case of an allergic reaction) *

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