Allergies

Mercyhurst Preparatory School Dining Services

School Payment Portal

Food Allergies and Sensitivities Form

To better serve you, please complete the following for our culinary team. A member of our management team will review and will contact you within 48-hours.

* Indicates required field

Child's Name *

First

Last

Your Name *

First

Last

Your Phone Number *

PLEASE CHOOSE YOUR CHILD'S ALLERGIES FROM THE LIST BELOW *

Fish Shellfish Tree Nuts Peanuts Dairy Eggs Soy Wheat Sesame Other

Other *

Your Email *

HOW SEVERE IS THE ALLERGY? *

WHAT TRIGGERS THE ALLERGY? E.G. INGESTION, INHALING, CONTACT, ETC. *

DOES YOUR CHILD WEAR A MEDIC ALERT BRACELET *

Yes No

DOES YOUR CHILD CARRY AN EPIPEN? *

Yes No

IS THERE ANYTHING ELSE WE SHOULD KNOW ABOUT YOUR CHILD'S ALLERGY? *

Submit

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​Food Allergies and Sensitivities Form

Food Allergies and Sensitivities Form