Medical and Allergy Form
The health information the adults in the room need to keep your child safe, and how we protect it.
Purpose
This form tells the adults in the room what to watch for and what to do. It covers allergies, medical conditions and medication. If your child has none, simply answer "none."
Fill it out online: part of full registration, which opens only after every launch-checklist item is complete. Until then the online form is an interest list that doesn't ask for this. Printable version (for full registration after launch): medical-allergy.pdf
Every field
| Field | Why |
|---|---|
| Allergies (food, insect stings, medication, latex, other) and the reaction | So we can prevent exposure and recognize a reaction quickly. |
| Does your child have a Food Allergy & Anaphylaxis Emergency Care Plan (FARE form)? | If yes, we follow it exactly, and you'll give us a signed copy. |
| Rescue medicine (epinephrine auto-injector or inhaler) | Rescue medicine stays within reach of the trained adult, not locked away. |
| Other medication needed during class | Must come in its original pharmacy container with a signed authorization, and is kept locked. |
| Medical conditions staff should know about (for example asthma, seizures, diabetes) | So staff know the signs and the steps. |
| Hearing, vision or sensory notes | Helps with headphone fit, volume and seating. |
| Anything else that would help | Optional. |
Our commitments
- We follow each child's FARE plan.
- Epinephrine is used per the child's plan, and 911 is called every time it's used. Then we call you.
- No food is shared without parent permission.
- At least one adult per class will hold current pediatric first aid/CPR/AED certification. This is a launch requirement and isn't done yet.
See the medical and allergy plan, the epinephrine protocol and medication storage.
Who sees it
Coaches and Stephen Henry only. It's stored privately and never sent to the class page. In an emergency, we share what's needed with 911 responders. Adults working in your child's class are told what they need to know to keep your child safe.
How long it's kept
It's kept as part of the registration record for 3 years for safety and insurance purposes, then deleted (policy commitment). You can update or correct it any time.
What happens after you submit
If you list allergies, medication or a condition, Stephen Henry will contact you before the first class to go over the plan and collect any signed authorization or FARE plan. Contact him at 872-255-9333 or stephen@selassiefest.com.