The Allergy Release Form is designed for use in situations where individuals with known allergies may be exposed to potential allergens during activities or services provided by an organization. This document, compliant with Irish law and regulations, serves multiple purposes: it documents known allergies, establishes emergency protocols, and defines liability boundaries. Organizations typically require this form when providing services where allergen exposure is possible, such as in educational institutions, food service establishments, or recreational facilities. The form includes crucial information about the individual's allergies, emergency contacts, and medical authorization, while incorporating necessary legal protections and compliance with Irish data protection requirements.
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1. Parties: Identification of the organization seeking the release and the individual (or guardian) providing the release
2. Background: Context of the potential allergen exposure and purpose of the release form
3. Definitions: Clear definitions of key terms including 'allergen', 'allergic reaction', 'medical emergency', and 'reasonable precautions'
4. Allergy Declaration: Section for individual to list and describe all known allergies and previous reactions
5. Risk Acknowledgment: Statement acknowledging understanding of potential risks and exposure possibilities
6. Emergency Contacts: Contact information for emergency situations and medical providers
7. Emergency Response Authorization: Authorization for emergency medical treatment if needed
8. Release of Liability: Core waiver language releasing the organization from liability for allergic reactions
9. Governing Law: Specification that Irish law governs the agreement
10. Execution: Signature blocks and date of execution
1. Medical Protocol: Used when specific medical procedures or protocols need to be followed in case of exposure
2. Medication Authorization: Include when the organization may need to store or administer medication
3. Photography Consent: Used in educational or childcare settings to ensure staff can identify individuals with allergies
4. Term and Renewal: Include for ongoing relationships where the form needs periodic renewal
5. Specific Activity Waiver: Added when the form relates to specific events or activities with known allergen risks
1. Schedule A - Allergen List: Detailed list of all potential allergens present in the environment or activities
2. Schedule B - Emergency Action Plan: Step-by-step protocol for responding to allergic reactions
3. Schedule C - Medical Information Form: Detailed medical information including allergy history and current medications
4. Appendix 1 - Emergency Contact Details: Comprehensive list of emergency contacts and their contact protocols
5. Appendix 2 - Medical Authorization Forms: Any required medical authorization forms from healthcare providers
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Risk Manager
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Childcare Director
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Safety Officer
Operations Manager
Food Service Director
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