Oak Ridge Baptist Church - Child Allergy Info Form

Child Allergy Info:

Please use this form for each child. For any major allergic actions we will always call you first unless otherwise specified below. Please be specific on treatment and symptoms.
Regarding food preferences, we will do our best to accommodate but please be aware that sometimes we cannot catch all preferences, such as food dyes.

Child's Name

Grade

Age

Date Of Birth

Parent/Guardian Name

Relationship to Child

Best Phone Number for emergencies

Additional Emergency Contact

Relationship to the child

Emergency Contact Phone Number

Food Allergies/Preferences

Food Preferences to avoid.

Food Allergies: Please list all.

Is the child aware of their food allergy and what needs to be done to manage it?
Yes
No

List Minor Symptoms and what to give the child.

Do you prefer immediate phone call for minor symptoms? (We will always call on any major symptoms)
Yes
No

List Major Symptoms and what to give the child.

Major Allergic reaction: Call 911 before calling parent/guardian?
Yes
No

Any other comments:

Send

Child Food Allergy Form

Child Allergy Info:

Food Allergies/Preferences

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