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The mission of the 5 and 2 Training Institute is to be an advocate for the fatherless children impacted by parental incarceration with a safe and supportive home, hands-on education, and practical skills, empowering them to build a secure and self-sufficient future.

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    5&2 Training Institute Food Allergies and Medical Conditions Form

    STUDENT INFORMATION
    Name
    MM/DD/YYYY
    ALLERGIES
    Do You have any Food Allergies?
    Reaction Severity
    Symptoms of Allergic Reaction (check all that apply)
    Is epinephrine (e.g., EpiPen) required for severe reactions?
    ALLERGY MEDICATION INFORMATION
    Are you taking any medications related to your food allergies?
    Frequency
    Frequency
    Do you carry the medications with you at all times?
    Have you ever experienced an anaphylactic reaction?
    PRESENT MEDICAL CONDITION INFORMATION
    Frequency
    Frequency
    Frequency
    Do You have any Medication allergies?
    AUTHORIZATION AND ACKNOWLEDGEMENT
    By completing this form, I authorize 5&2 Training Institute to share my food allergy and medication information with dining staff, residential life staff, and other necessary personnel to ensure my safety. I understand it is my responsibility to provide updated information as necessary.
    Type Your Name
    MM/DD/YYYY

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