Daycare Food Allergy Management Plan
Child Information
Child’s Name
Date of Birth
Classroom/Group
Parent/Guardian Information
Name
Phone Number
Email
Allergy Details
List of Food Allergens
Description of Reaction
Signs & Symptoms to Watch For
Emergency Plan
Steps to Take if Exposure Occurs
Medication (e.g., EpiPen) & Dosage
Physician’s Name & Contact
Other Notes
Parent/Guardian Signature
Date
Staff Signature