Tipton Academy

Tipton Academy
 
1515 Belton St. Garden City, MI  48135
 
 
ALLERGY LIST
 
 
Student’s Name:_________________________________________________________
 
 
Teacher’s Name:_________________________________________________________ 
 
 
 
Yes, my child has allergies. 
 
No, my child does not have allergies.
 
 
List allergies in detail: 
 
 
Parent/Guardian’s Signature                                                               Date