Pupil Allergen Form

Parental Child Questionnaire
(page 1/3)

Parental consent to data processing

The personal data within this form will be gathered, stored and used to ensure that every child is served with a safe meal for them to enjoy. Where the criteria have met the requirements within our Medical Diet Policy, the information will be used during future communications with the parent/carer.

More information about how your child's personal data will be accessed and stored is available in our Medical Diet Privacy Notice.

Please tick the box below to indicate that you are happy for your child's personal data to be processed for these purposes. Consent is required even if your child does not have any allergies / intolerances. You may withdraw consent at any time, but please be advised that we will not be able to provide a medical diet, if required for your child.

Please note that if any information changes in respect of food allergens / intolerances, you must notify us by completing this form again.

We will be reviewing the information we hold on your child every year to ensure that the information is still up to date and accurate and as a result we may need to contact you direct. Please advise us if any of your contact details change.

I have read and understood the above

Thank you, we have your data securely stored and will contact you regarding any questions we have.

If your details change in the future, please simply complete this form again.

Your First Name:
Your Last Name:
Mobile Phone:
Email:
Relationship to pupil:

Pupils First Name:
Pupils Last Name:
School Name:
Class Name:
Pupil Address Line 1:
Pupil Address Line 2:
Pupil Town / City:
Pupil Postal Code:
Pupils Date of Birth:

UCI optional:
ULN optional:
UPN optional:

Does your child have a food allergy / intolerance? Yes No

Additional information / comments: