Under 18- My Allergy Card Registration Form
Thank you for registering to receive a My Allergy Card.

After you fill out the form, Allergy Life Australia will email you with a link and instructions on how to install the My Allergy Card.

If you have multiple children, please fill out a new form for each child.

The details you fill out below are used for internal purposes only to set up and create your card, and are not shared publicly or to any third parties. We may use the registration information to validate details with your child's school (to ensure they are Allergy Aware). For any questions, email contact@allergylife.com.au
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Your Name (Adult applying on behalf of child) *
Your Email Address (for verification) *
What Australian State or Territory are you from? *
Who is this Card for? (Full name of child) *
You Relationship to Child? *
When were they born? (DD/MM/YY) *
Are they in School? *
If they are in school, what is the name of their school? (This is for validation purposes)
What do they have from the below? *
Required
Please list their allergies/intolerances/conditions below (.i.e. Wheat Allergy, Tree Nut Allergy, Peanut Allergy, Shellfish Allergy, etc) *
What emergency instructions should be listed on their  card? *
List emergency phone number (if part of emergency instruction)
Which colour would they like? *
What type of Smartphone device do they have? If you will add this to your phone, let us know what smartphone device you have. (This is for any technical queries)
Do you have any questions?
What happens after you submit? We will set up your card and email it to you within 5 business days. If you have any questions or queries email us at contact@allergylife.com.au
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