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Request for child to carry his/her own inhaler

Request for child to carry his/her own inhaler

This form must be completed by parents/guardian. Medication must be in the original container as dispensed by the pharmacy.

Child's full name* Class* Name of medicine* Dosage* Procedures to be taken in an emergency* I can confirm that my child has been prescribed a Ventolin inhaler.* I would like my son/daughter to keep his/her inhaler on him/her for use as necessary. I understand that it is my responsibility to ensure my child has a working in-date inhaler in school at all times and that the medication is clearly labelled with their name.* I acknowledge that my child will not be able to leave school premises without their own inhaler (e.g a school trip).* In the event of an emergency evacuation from the school, and should my child require an inhaler I consent for my child to use an emergency inhaler held by the school for such emergencies.* Main contact name* Daytime phone number* Relationship to child*

Almond Hill Junior School

Request for child to carry his/her own inhaler

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