Allergy Forms

(Only to be filled out for children who have allergies)

  • Date Format: MM slash DD slash YYYY
  • Please make sure that we have all necessary items to deal with an emergency.
  • Name Phone Actions
       
    There are no Contacts.

    Maximum number of contacts reached.

    (Please provide at least 3 Emergency Contact)
  • I hereby request and authorize the Anshei Lubavitch Day Care Center (ALDC) personnel to administer medication to my child as directed by my physician. I agree to release, indemnify and hold harmless ALDC and any of its officers, staff members, or agents from lawsuit, claim demand, or other action against them for administering medication to this student.

    ALDC will make all reasonable efforts to give medication in a timely fashion, but the final responsibility for administration of medication rests with the parents. Please note that we require that all medication be in the original prescription bottle or packaging.

  • Date Format: MM slash DD slash YYYY