Corn Free Snacks
Healthy Snacks
For My Child's Safety

Dear Parents or Caregivers,

Below is a short form entitled allergen free (corn free) snacks which should be filled out and given to any person(s) which temporarily helps you in caring for your child. A small set of instructions is included at the top of the letter. Fill in this information on each numbered line so the teacher, babysitter, grandparents etc. understands what the problem is and how to eliminate any barriers to your child's safety. Copy this form, fill it out and then be sure each caregiver is given a copy for their records.

#1 This line would say--- Type of snack such as Corn, Dairy, Dye, Egg, Gluten, Peanut, Soy, or Tree Nut free snacks or any other type of allergy

#2 This line would say--- Child's First Name on this line

#3 This line would say--- List Of Allergens: include items such as milk, ice cream, pudding or anything with milk in it. Use whatever applies to your child's allergy.

#4 This line would say--- Peanuts, Eggs, Gluten or Wheat products etc.

#5 This line would say--- Telephone Number where you can be reached/ Alternate number also in case of emergency

#6 This line would say--- Parent(s) or Caregivers Signature- Sign your name here please

Allergen Free Snacks

#1___________________ - Free Snacks are a way of life for my son/daughter #2___________________. This is because he/she is allergic to any items which contain #3_________________________.

Please understand the importance of the situation when I request your help in keeping my child safe. In some situations, just by smelling or accidentally touching #4____________________________ products, my child can get an adverse reaction known as anaphylactic shock. It is entirely possible this can lead to a severe set of symptoms which requires immediate medical treatment. Sometimes it can even lead to death.

Below I have a list of safe products my child may have which do not include his/her allergen. During lunch, snacks, parties etc., as long as my child uses any product from this list he/she will be safe. Please understand though, my child's "safe snack" can not come in contact with any "unsafe product". An example is a "safe apple" can no longer be consumed if packaged in a bag with a peanut butter sandwich. This will create an allergic reaction on anyone with a peanut allergy. This is called cross contamination.

Finally, it is important to understand that a safe product from one company does not automatically mean every company that makes that item is safe also. Different companies use different ingredients. I must be able to read the ingredient label before my child uses any product from a different company. I am trying to teach my child every food item must be 100% guaranteed safe (by checking the label or calling the manufacturer) before he/she can touch or eat any of that product.

You are going to be the caregiver of my child for a portion of his/her day. Please help me to keep him/her safe!

If you have any questions, do not hesitate to call me at #5__________________________________________________________.

Thank You!

#6_________________________________________________________
Parents or Caregivers

List Of Corn Free Snacks