Food Allergy Assessment Form (2025 - 2026)

Dear Parent/Guardian,

In order to avoid any health related incidents during this school year, we are asking parents  to please read and answer the questions included below. We will personally reach out to you if further information  is needed.

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What is your child's name? *
What is your child's grade? *
What is your child's class *
1) Does your child have any food allergies? 

If your answer is YES, please continue with the following questions.If your answer is NO, then please go to the bottom, sign and submit this form.

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2) Has your child’s food allergy been confirmed by a doctor?        
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3) Is your child’s food allergy life-threatening?    
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4) Have you submitted a Medical 504 form to the Medical Office?     
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5) Who in the school is aware of your child’s condition?
6) Check the foods that may cause an allergic reaction to your child (check all that apply)    
7) What has to happen for your child to react to the problem of food? (check all that apply)    
ACKNOWLEDGEMENT

I have read and understood the information included in this document.

I’m aware that it is the parent’s/guardian’s responsibility to inform the school of any health conditions, including allergies, that may cause harm to your child. Parents are also responsible for updating the school of any new allergies or medical conditions.  

Please type your full name as acknowledgement of this form.


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