Food allergy & intolerance notification

This form should be completed by the parent or guardian of ALL pupils under the age of 18.

Name of Pupil*

First Last

Date of birth*

Year Group on Entry*

Part 1: To be completed by parent/guardian

1A. Does your child have an allergy/intolerance/food preference?*

No Allergies/Intolerances

Yes – Please tick the relevant box or boxes below

If Yes, please tick all that apply from the list of allergens (please select all which apply).*

Other Allergens/Intolerances*

If you ticked any of the above boxes please provide further details of the nature of the allergy/intolerance*

1B. Has this Allergy or Intolerance been medically diagnosed? (If yes, please provide a medical note to the school)*

Yes

1C. Does your child have an EpiPen or autoinjector?*

Yes

1D. Do you require a meal to be prepared and plated separately from the main dishes?*

Yes

2A. Does your child follow a Religious diet?*

Yes

2B. If you ticked YES, please provide further details.*

3A. Has your child chosen to follow any of the following dietary preferences?*

Vegetarian

Vegan

Pescetarian

No preference

1D. Where a pupil’s requirements are very complex (for example multiple allergies, severe allergies which have been medically diagnosed or medically diagnosed allergens that do not fall under the 14 listed allergens of the Food Information Regulations), it may be necessary to provide the pupil with a plated meal. The menu cycle for this pupil will be planned and a meal will be prepared in a separate area or at a separate time from the meals containing the pupil’s allergens. The meal will be wrapped and labelled to protect it from cross-contamination and checked by two members of the catering team.

Part 2: Parent/Guardian Acceptance

Whilst Thomas Franks can provide meals which do not include nominated allergens, they cannot guarantee that dishes do not contain traces of allergens, as they will be stored and prepared in the same areas as nominated allergens. There is a risk of cross contamination on display counters, particularly self-service areas such as salad bars and dessert counters. Please be aware that while Thomas Franks do not use nuts in any of the food they prepare and serve, they 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 their suppliers. Once this completed form has been received, a meeting can be arranged between the catering manager, school and the parent/guardian to discuss your child’s food requirements in more detail.

Name of Parent/Guardian completing this form*

First Last

Daytime contact telephone number*

Email address*

Date*

School life

Parents, Pupil and staff Area

Charity

Junior school

Senior school

Sixth form

Food Allergy/Intolerance/Food Preference Notification

This form should be completed by the parent or guardian of ALL pupils under the age of 18.

Part 1: To be completed by parent/guardian

Part 2: Parent/Guardian Acceptance

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