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Allergy/Asthma Action Plans/Forms

Dear Families,
The state has released new forms for Allergy and Asthma Planning -required documents to be accompanied by the Authorization for Medication. Please read carefully the following information to determine if you are required to submit these forms:

1. Does your child have a diagnosis indicated in his health inventory of an allergy or asthma of any type? If your answer is yes, proceed to question two. If your answer is no, you do NOT need these forms.

2. Does your child’s allergy or asthma diagnosis indicate that it may require rescue medication in the form of benadryl or other antihistamine, epi-pen, an inhaler or any other medicine? If your answer is yes, proceed to question three. If your answer is no, you do NOT need these forms.

3. Please print the forms below. Fill them out appropriately in concert with your child’s allergist’s office, and submit them by Aug. 1, 2016, along with the appropriate medications, new and unopened.

Please note:
-Prescription medication must be in a container labeled by the pharmacist or prescriber.
– Non-prescription medication must be in the original container with the label intact.
-An adult must bring the medication to school office staff (please never place medication in your child’s backpack or hand it to the teaching staff in the classroom)

Thank you for your cooperation.
Saint Luke Christian Day School

Allergy Action Plan

Asthma Action Plan

Medication Authorization Form