Food Allergy Form

Full name of student *

First

Last

Date of birth *

We endeavour to ensure that we provide tasty, healthy, nutritious food for all our students. In order to ensure that we are able to cater for your son/daughter’s food allergies/religious beliefs/tastes please complete this form as fully as possible. First part to be completed by the parent and second part the student

Allergy/Intolerance (Completed by parent)

Does your son/daughter have an allergy or intolerance to any of the following allergens? If yes please check the box or leave blank if no.

Type *

If you have ticked yes to any of the above, please give further details on the nature of the allergy/intolerance

Has this allergy or intolerance been medically diagnosed? *

Yes
No

Our catering company use a colour coded system to identify special diets. Please select which applies to your son/daughter:

Type *

RED - Students has a severe life-threatening allergy / anaphylactic shock
AMBER - Students has an allergy or intolerance
BLUE - Student excluded foods due to preferences including religious beliefs
N/A

If you have clicked red:
Where our catering company cater for students under the age of 16 with a special diet in the RED category, we strongly recommend that a freshly prepared pre-plated meal is provided for them. A pre-plated meal is the safest way to minimise the risk to the student. If you DO NOT want a pre-plated meal to be provided then please complete the section below. Once this complete form has been received, a meeting can be arranged between the catering manager and the parent/guardian to discuss your son/daughter's food requirements in more detail.

If you have ticked red, please specify if you would like a freshly prepared pre-plated meal or not *

Yes
No

I am aware that:

Our catering company 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.

The meals provided to your child will be stored and prepared in the same areas as nominated allergens.

There is a risk of cross-contamination on display counters, particularly at self-service areas such as salad bars and dessert counters.

Religious Preferences

Please provide details of non-permitted foods due to religious faiths and beliefs

Data Protection

I am happy with my son/daughters allergen information and photo (where provided) to be:

Passed to our catering company to enable them to assist the college in correct for provision. *

Yes
No

Displayed next to the main servery area to enable catering staff to check allergy information. *

Yes
No

Student Food Preferences (Completed by student)

To help us prepare the types of food you like please give us as much information as possible, so that we can plan our menus around your tastes (as far as reasonably possible). We aim to make your meals enjoyable so if you have any comments please do come and talk to us.

In general, I will eat anything *

Agree
Disagree

There are a few things that I do not like *

Agree
Disagree

I only eat certain foods/dishes *

Agree
Disagree

Please tick the following foods you like/eat *

Please list some of your favourite dishes below and we will endeavour to include them in the weekly menus

I confirm that the information supplied within this document is correct *

Yes
No

Date *

Parent/Guardian Signature *

Clear Signature

Child Signature *

Clear Signature

Allergy/Intolerance (Completed by parent)

Religious Preferences

Data Protection

Student Food Preferences (Completed by student)

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