Asthma, Allergy and Medication forms for BALARAT

Posted 05/01/2017

5th Grade is going to Balarat on May 18th and 19th.

If your student takes medication at home that they’ll need during their overnight Balarat trip, we absolutely need the forms below completed by the Parent and the Physician. Otherwise, we won’t be able to administer any medication during the trip.

This is the form required for any student that needs Asthma care during the trip:

Asthma Action Plan - Albuterol Med Order

This is the form required for any student that needs Allergy care during the trip:

Anaphylaxis Action Plan -Epinephrine Med Order

This is the General Medication form for any student that will need to take medication during the trip (THIS INCLUDES OVER-THE-COUNTER MEDICATION):

Student Med Treatment Release Agreement - Eng 17-18