HARRISON CATERING SERVICES LTD
FOOD ALLERGY & FOOD INTOLERANCE MANAGEMENT

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* 1. Pupil and Parent Details

Name of parent

Name of child

Address

Postcode

Telephone Number

Email Address

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* 2. Have you had a letter about managing Food Allergies and Food Intolerance? The letter can be found here. Please note you must read this before your child starts school.

Yes

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* 3. Tick the box next to the foods to which your child is allergic or intolerant

My child has no intolerance to allergies to any food

Peanuts

Fish

Nuts

Seafood

Milk

Sesame

Gluten

Eggs

Soya

Celery

Lupin

Mustard

Sulphur Dioxide

Can you detail if these are allergies or if your child is intolerant.

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* 4. Is your child allergic to any other food item?

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* 5. Is a copy of a medical diagnosis available and can Harrison and the school view it?

Yes

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* 6. Has your child suffered a previous allergic reaction to any of these foods?

Yes

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* 7. Is the allergy life threatening?

Yes

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* 8. I understand that I am responsible for ensuring that accurate information about the food allergies or intolerances affecting the child named above is given to the school and the caterer and for the need to notify any changes in relation to the food allergies or intolerances suffered by my child.

I consent to such information being shared between the school and the caterer (Harrison Catering Services Limited)

Yes

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* 9. I give permission for a photograph of my child to be displayed in the kitchen to assist in correctly identifying my child when being served?

Yes

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* 10. Parental Signature

Name

Signed

Date

I am happy to have a telephone conversation to confirm details regarding my child if Harrisons feel it necessary.

Please note that whilst all reasonable precautions will be taken to make sure the food is safe for your child to eat, there can be no absolute guarantee that the food will not contain anything to which your child has an allergy or intolerance

HARRISON CATERING SERVICES LTDFOOD ALLERGY & FOOD INTOLERANCE MANAGEMENT

Question Title

* 1. Pupil and Parent Details

Question Title

* 2. Have you had a letter about managing Food Allergies and Food Intolerance? The letter can be found here. Please note you must read this before your child starts school.

Question Title

* 3. Tick the box next to the foods to which your child is allergic or intolerant

Question Title

* 4. Is your child allergic to any other food item?

Question Title

* 5. Is a copy of a medical diagnosis available and can Harrison and the school view it?

Question Title

* 6. Has your child suffered a previous allergic reaction to any of these foods?

Question Title

* 7. Is the allergy life threatening?

Question Title

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* 9. I give permission for a photograph of my child to be displayed in the kitchen to assist in correctly identifying my child when being served?

Question Title

* 10. Parental Signature

HARRISON CATERING SERVICES LTD
FOOD ALLERGY & FOOD INTOLERANCE MANAGEMENT