Free Daycare Allergy Form & Guide

As a daycare provider, you must keep the children you care for safe, and one important element is a daycare allergy form. Over 50 million people experience allergic reactions, including infants, toddlers and preschool-age children. If you don't have a way to identify children's allergies, it's impossible for your staff to do their jobs effectively.  

We've provided this sample allergy form for daycare to ensure that parents and caregivers have a straightforward way to communicate their children's health needs. According to Elijah's Law, parents or guardians must complete their child's daycare allergy forms before a child can safely attend a licensed daycare program. When you have the correct information on a child's allergy daycare forms, your employees can provide the highest level of care without fear of incident.  

Our free daycare allergy form is below. You can download the free editable forms below. Or use the text below to build your own. 

• PDF 
• Word Doc 

Daycare Allergy Form: Basic Information 

Please clearly print responses to the following questions. 

1. What is your child's full name? 
2. What is your child's day of birth? (mm/dd/yyyy) 
3. List the first and last names of the child's parents or guardians.  
4. What is the best contact number for each parent or guardian? 
5. Please provide a second contact number (i.e., work number, house number) for each parent or guardian, if available.  
6. Which parent or guardian should we contact first in the event of a medical emergency? 

Medical Contact Information 

Please clearly print responses to the following questions.  

1. What is your child's physician's name? 
2. What is your child's physician's phone number?  
3. What is your child's physician's address?  

Emergency Contact Information 

Please list three individuals we can contact if you are unavailable during a medical event. Include their relationship to the child (i.e., babysitter, aunt, neighbor) and their best contact phone number.  

1. Emergency Contact #1: 
2. Emergency Contact #2: 
3. Emergency Contact #3: 

Allergies and Reactions 

Please circle or place a check mark next to the items your child is allergic to.  

• Peanuts/peanut products 
• Tree nuts 
• Milk 
• Eggs 
• Soy/soya products 
• Gluten 
• Seafood/shellfish 
• Bee stings 

• Other (please print):  

If you selected at least one item above, please answer the following questions. Be detailed. The more information you provide, the better we will be able to assist your child during a medical event.  

1. What specific triggers cause an allergic reaction in your child? Please describe the triggers for each allergy indicated above. 
2. What foods, items or experiences should your child avoid to prevent a reaction? (For example, can your gluten-free child use flour-based Play-Doh? Can your child be in the same room as peanuts? Will you be providing meals and snacks?) 
3. Describe, in detail, the signs and symptoms that manifest when your child is experiencing an allergic reaction. Please provide details for each allergy indicated above.  
4. What treatments or medications, including doses, should your child receive in the event of an allergic reaction? 
5. Describe the procedures your child's care providers should follow in the event of an allergic reaction. (For example, should we call 911 or attempt to contact a caregiver first? If your child requires treatment or allergy medications, are they on-site?) 

How to Put Together a Daycare Allergy Form

Are you wondering what to include in the allergy form you use at your daycare center? 40 percent of children in the United States have an allergy of some kind. 

As an owner or manager, the safety of the children at your daycare is of paramount importance. A crucial part of providing a good environment for your students is to be proactive about your focus on their safety. 

Read on to learn why this form is important and how to put together a daycare allergy form! 

Primary Considerations 

The daycare allergy form template you use should include all the information you may need in the future. For starters, the form must identify the full name of the child and the parent or legal guardian completing the document.  

Because a child's allergies may change over time, be sure to include a space on the form for the adult to fill out the date they sign it. This will help you and your staff ensure your center maintains current and accurate records. 

The allergies section of the form should have enough space for the person completing it to write each allergy. Without enough space to write, you are at risk of having illegible or incorrect information. 

Storing and Using This Information 

In today's digital age, where and how you store allergy forms for daycare is an important consideration. 

For ease of access and storage purposes, maintaining the forms on a secure computer server is a good idea. Because these forms contain personal health information, this triggers HIPAA concerns. 

What is HIPAA and why is it important? HIPAA stands for the Health Insurance Portability and Accountability Act. The legislation became law in 1996 and impacts how hospitals or other businesses protect individuals’ health information.  

You should limit the number of employees that have access to this information. Keep this data private and never share it outside of your daycare center. 

HIPAA violations can subject your business to expensive fines or other regulatory issues. These can have a negative impact on your revenues and damage the reputation of your daycare. 

When to Request a Form 

A good rule of thumb is that it's never too early to request allergy information about a new student.  

Never wait to request that parents complete and sign this form. To protect your business and the safety of the child, it's a best practice to require parents to return the form before a child starts attending your daycare. 

Make sure your records are kept up-to-date at all times. Include a statement on the form that requires the parent or legal guardian to notify you in writing if allergies change for their child.  

At the start of a new school year, you should also request that each child’s parent complete a new food allergy form. This helps you avoid having inaccurate health information about any student. 

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