Allergy Notification Form 

We take the welfare of the children attending birthday parties at Marshmallow Manor extremely seriously. Therefore we kindly ask that you complete this Allergy Notification Form to make us aware of any guests with allergies, the extent of such an allergy, and to provide us with an emergency contact telephone number. Please note, that we cannot cater food for severe allergies of any kind. 

Please use one form only per guest.

It is important that we receive this information prior to the party date. 

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Guests Name

Date of Birth

Party Date & Time

Date

Time

will complete epipen

Type of Allergy

Are you aware Under what conditions might the guest experience an allergic reaction? air born / skin contact / oral consumption / other.

Could you advise on details, what potential reactions the guest may have? (Likely and possible).

Are you aware if the guest’s allergy poses the risk of anaphylactic shock?

Could you advise is there anything the guest is already doing to mitigate the chance of reaction? e.g. medication, epipen or other?

What medication First Aid does the guest require if they were to have an allergic reaction?

Would the guest ever need assistance with the administration of medication?

• Yes
• No

Could you advise on details as to what steps staff would need to take if the guest had an allergic reaction

Would assistance from a first aider be acceptable if trained to assist.

• Yes
• No

If applicable, where would the guest keep any medication, epipen etc whilst attending the party? (eg. on themselves, or at our reception)

Should we need to contact you under any circumstances, please complete the contact details below:

Name

Phone

Disclaimer

Whilst Marshmallow Kids Ltd will endeavour to ensure the safety of all children with any medical or allergens we cannot guarantee cross-contamination or be held responsible for any allergic reactions. We request that a guardian of the guest with an allergy remains on-site for the duration of the party and will be responsible for the guest. *

• I agree

Submit