Allergy Survey | Charlottesville Day School

This survey is designed to obtain information concerning life-threatening allergies.

Child's Name

First Last

Parent 1 Name*

First Last

Parent 1 Email*

Parent 2 Name

First Last

Parent 2 Email

Allergy Policy

We have many children attending Charlottesville Day School with moderate to severe allergies. To best provide an environment safe for all of our students:

Parents must notify CDS in writing of any current or past allergy or sensitivity prior to the beginning of the school year or immediately when diagnosed.
Parents must provide CDS with a doctor recommendation for any known allergy or sensitivity.
Parents must provide CDS with any medication, including an EpiPen, in its original container with the prescription attached. Medication can not be expired or it will not be accepted by CDS staff.
Teachers will meet with parents of children with an allergy or sensitivity and develop an action plan for that child.
Action Plans for children with allergies will be posted for easy, immediate access.
Teachers will make necessary and reasonable accommodations within the classroom to ensure every child is safe.

Does your child have a known allergy?*

Does your child have any allergies to a particular food, insect sting/bite, etc. that causes an allergic reaction? If yes, please be specific and explain*

Is your child asthmatic?*

Has your child been evaluated by a doctor for allergies?*

Has your child been prescribed an EpiPen for any known allergy?*

I agree that this information will be shared, as necessary, with administration and staff to provide a safe atmosphere at CDS for my child.*

By checking this box, you are agreeing to the statement above.