This document is a notification form for parents to inform teachers of any food or environmental allergies their child has. Parents are asked to list any known allergies their child has or note that they have none. For any allergies listed, parents can provide instructions for treating an allergic reaction.

1. Food/Environmental Allergy Notification________My child has no known allergiesPlease make note of any known food and/or environmental allergies that your child may have:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If your child has any allergies please provide special instructions as to treatment of a reaction:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Date________________(Signature of parent/guardian)