PAK Membership Application

Enroll today as a Protect Allergic Kids Member for FREE.  All information is not required.  Your information helps PAK develop a confidential database to better serve you.

Privacy Policy: PAK does not sell or share our donor list or e-mail lists with other organizations or businesses.

Contact Information 

First Name:    

Last Name:  
Main Address (all mailings sent to this address)

Street Address:  




E-Mail Address:
Age of Child:

Anaphylactic to:

Asthma (yes/no):
Other Diagnosis:

How did you hear about us?

Please add your questions and/or comments here (then Click on Submit)

PAK is not a professional or medical organization.  It is a group of parents sharing information and supporting each other.  The discussions, meeting minutes, handouts, guest speakers, agendas, and other products of our support group do not constitute medical/legal advice and should not be relied upon as such.  Always discuss individual health questions and medical issues with a qualified personal physician.  In regard to Guest Speakers, the purpose of the presentations is to provide a variety of opinions on the spectrum on allergy issues. By no means is PAK adopting the views of its speakers, or endorsing them as medically accepted in the community. It is up to the guests to weigh the persuasiveness and acceptability of the presentations, based on their own knowledge and research. 

Does your child have severe food allergies?
You've come to the
right place.