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Allergy Notification Form

Information about my child's special diet

Section A: General Details

Section B: Declaration

I confirm my child has a food allergy, intolerance or other dietary-related medical condition that needs addressing. The information in this form IS NOT about my child's food preferences. I agree to information about my child's allergy and any related doctor's or registered dietician's medical assessment being provided to the School's catering partner, Sodexo (including any other relevant personal data, like photographs, if I've agreed with the School), soley so that they can provide the right alternative meals for my child.

Does your child have a food allergy?*

Please indicate YES if your child has an allergy to any of the items listed. Please include as much information as possible about your child's food allergy in the space provided. For example, can they tolerate products that say 'may contain traces'; what types of nut are they allergic to or should they avoid all nuts? Should they avoid all forms of the allergen or can they tolerate some forms for example raw, baked or cooked? Please provide a copy of any relevant medical assessment or confirmation.

 Yes/NoPlease provide as much detail as possible
Cereals (containing gluten)
Nuts (specifically which kind)
Sesame Seeds
Sulphard Dioxide (Sulphate)
Does your child carry an Epipen*
Does your child suffer from a medically-diagnosed, dietary-related condition (like Coeliac disease)?*
Does your child have any food intolerances? This may not be medically diagnosed*