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Daycare Allergy Form Template

Easily Protect Children with Our Customizable Allergy Form

Keeping kids safe from allergens is a top priority for every daycare. This daycare allergy form helps you collect essential information from parents about their children's allergies, allowing you to create a safe environment. With this template, you can streamline registration, improve communication with parents, and ensure compliance with safety regulations. Plus, it's designed with WCAG-aligned labels for accessibility. Start using this template to make allergy management easier for you and the families you care for.

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Child full name
Date of birth
Primary classroom or group
Other medical conditions or notes (e.g., asthma)
Parent/Guardian full name
Primary phone number
Email address
Emergency contact full name
Relationship to child
Emergency contact phone number
Known allergen types
Please Specify:
Please list specific allergens and details (include brand/ingredient names where relevant)
Typical reaction symptoms (select all that apply)
Please Specify:
Is an epinephrine auto-injector prescribed?
Yes
No
Location of the auto-injector while at daycare
With child
Classroom
Front office/clinic
Not applicable
Other
Please Specify:
Medication details and dosing instructions (name, dose, when to administer, storage)
Epinephrine auto-injector expiration date
Other medications for allergy/asthma management at daycare
Antihistamine (e.g., diphenhydramine)
Inhaler (e.g., albuterol)
Topical steroid
None
Other
Please Specify:
Authorize staff to administer provided/prescribed medications as labeled
Yes
No
Additional instructions for staff (avoidance strategies, signs to watch for, steps to follow)
Authorize staff to call emergency services (911) if severe reaction or breathing difficulty occurs
Yes
No
Primary physician name
Physician phone number
Parent/Guardian name (type to sign)
Date signed
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Paper art illustration depicting a daycare allergy form with medical symbols and child-friendly designs

When to use this form

Use this form whenever you enroll a child with known allergies, receive a new diagnosis, or need to update a care plan before cooking projects, field trips, or holiday parties. It helps you brief teachers, aides, and kitchen staff on triggers, symptoms, and approved treatments so they can prevent exposures and respond fast. You can pair it with the Childcare center pre-registration form to collect health details upfront and confirm what medications will come to school. At daily drop-off, note any changes alongside your Sign in sheet form so all shifts see the latest instructions. The result: fewer close calls, faster decisions, and a consistent response even with substitutes.

Must Ask Daycare Allergy Questions

  1. Which allergies does your child have (food, medication, insect, latex, environmental)?

    Listing every allergen helps you prevent exposures in snacks, crafts, and outdoor play. It guides menu substitutions and classroom material choices.

  2. What specific triggers set off the reaction, and how severe is it (mild, moderate, anaphylaxis)?

    Detailing triggers and severity lets staff weigh risks and set the right precautions, such as separate seating or nut-free rooms. It also signals when emergency medication must be kept within immediate reach.

  3. What symptoms should staff look for, and how quickly do they appear after exposure?

    Early-warning signs and typical timing help your team act before symptoms escalate. Clear patterns improve training for substitutes and reduce delays.

  4. What medications or treatments are prescribed, including exact dosage and when to give them?

    Specific instructions reduce dosing mistakes and ensure care matches the doctor's plan. For urgent events, align these steps with your Child care emergency form so everyone follows the same protocol.

  5. Do you give consent for staff to administer medication (including epinephrine), and who is authorized to pick up after an incident?

    Documented consent speeds treatment when minutes matter and avoids legal confusion. Listing pickup contacts pairs well with your After school care sign out sheet form for a safe handoff.

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