Allergy Action Form - Mundelein Coop Preschool 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name and birth date in the designated fields at the top of the form.
3. Indicate any allergies by filling in the 'ALLERGIC TO' section, and provide the Epi-Pen expiration date.
4. Specify if the student is asthmatic by checking 'Yes' or 'No'. If yes, note if they are at high risk for severe reactions.
5. Review the signs of an allergic reaction listed on the form. This will help you identify symptoms quickly.
6. For minor reactions, fill in the symptoms and medication/dose to be administered, along with emergency contact information for parents and doctor.
7. For major reactions, clearly state suspected ingestion symptoms and medication/dose to be given immediately. Ensure to call 9-1-1 as instructed.
8. Finally, sign and date both parent’s and doctor’s signature sections to complete the form.

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