Allergy and intolerance form

Allergy and intolerance form

We understand that food allergies can present serious problems for some of our children. This form is designed to collect information about pupils who have allergies and intolerances so that we can cater for them appropriately.
This form must be completed by the parent or guardian of each pupil ahead of their initial taster session and at other times when this link is provided.

Food allergy and intolerance form

Child's details

Does your child have an allergy or intolerance to any of the following allergens?
Has this allergy or intolerance been medically diagnosed? 
We are unable to guarantee that dishes/products served are totally free from nuts/ nut derivatives, due to the use of precautionary allergy statements such as ‘may contain’ which are used by our suppliers. 
We cannot guarantee that dishes do not contain traces of allergens, as they will be stored and prepared in the same areas as nominated allergens. There is a risk of cross contamination on display counters, particularly self-service areas. 
Does your child exclude food due to preference or religion, e.g. vegetarian 
Our catering company Holroyd Howe use a colour coding system to identify special diets. Please tick which applies to your child 
We strongly recommend that a freshly pre-plated meal is provided for your child as it is the safest way to minimise risk. Are you happy with this option? 

I am aware that Holroyd Howe are unable to guarantee that dishes or products served are totally free from nuts/nut derivatives due to the use of precautionary allergy statements such as 'may contain' which are used by suppliers. The meals provided to your child will be prepared in the same areas as nominated allergens. There is a risk of cross-contamination on display counters, particularly at the self-service areas such as salad bars and dessert counters.

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I’m happy for my child’s allergen information and photo (where provided) to be passed to Holroyd Howe to enable them to assist the school in correct food provision. 
I understand my child’s allergen information and photo will be displayed next to the main servery area to enable the catering staff to check allergy information. 

Parent acceptance

I confirm that the information supplied within this document is correct. Any changes in my child’s allergy/intolerance status will immediately be highlighted to the school.
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