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Food/Environmental Allergy Notification ________My child has no known allergies Please 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: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ ____________________

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Page 1: Allergy Form

Food/Environmental Allergy Notification

________My child has no known allergies

Please 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)


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