• Allergy Form

  • Child's Name:   *   *   Date of Birth:   Pick a Date   

  • Please list any of your child’s allergies and any medical conditions that your child may have.

  • If my child has an allergy, I authorize my child’s name may be posted in the therapy rooms as a reminder to staff to prevent allergic reactions. This is very important to keep your child as safe as possible and involved in a healthy environment.

  • Clear
  • Should be Empty: