Food Allergy Questionnaire

To be completed by parent/guardian 

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Student Last Name *
Student First Name *
Student Grade *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Does your child have any food allergies? *
If yes, please list all known food allergies
Do you have a meal modification plan to provide for your child?
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If yes, Please email bmorris@dcsschool.com a copy of specific foods to avoid & a safe alternative food list
Parent/Guardian Acknowledgment: By checking the box I agree, I certify the information provided is accurate and consent to share it with school personnel for the safety of my child. *
Required
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