Child Food Consent Form
Please complete this form to provide consent for your child to receive food and snacks. Your responses help us ensure your child’s dietary needs and safety are met.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Other
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any food allergies?
*
Yes
No
If yes, please list all known food allergies:
Does your child have any dietary restrictions?
*
Yes
No
If yes, please specify the dietary restrictions:
Please indicate any food preferences or foods to avoid (optional):
Additional medical conditions or instructions we should know about:
Parent/Guardian Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: