Permission Forms

Simcoe St. U.C. Food Experience Permission Form

I give permission for my child ____________________ Birth date__________

                                                    Name (please Print)                          D/M/Y

To participate in food related activities.

Please check one of the following:

__________My child DOES NOT have a food allergy or dietary restriction.

__________My child DOES have a food allergy or dietary restriction.

He or she may participate, but may not eat or handle the

following items (please list below) ____________________________________

_______________________________________________________________

___________My child DOES have a food allergy or dietary restriction.

He or she may not participate in activities.

__________________________       ______________________

Parent/Guardian Signature                                Date

__________________________       _______________________

Email Address                                    Phone number