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Please complete this form if your child has any dietary requirements in respect of allergies, intolerances or religion.

Please note it is not necessary to complete a form if your child has no dietary requirements.

Please complete one form per child.

Select one of the following*
Is your child allergic/intolerant to any of the following:*
Has this allergy or intolerance been medically diagnosed?*

If YES, please provide the school with written advice from a doctor or dietitian. This should be emailed to and will be kept confidentially with your child's records.

Has your child suffered a severe allergic reaction or anaphylactic shock symptoms in the past?*
Does your child carry an EpiPen*

If your child's dietary information changes then please email