Parkside Primary School

Parkside Primary School - Asthma Notification Form

If your child has been medically diagnosed as having asthma, it is a requirement that we hold detailed information of medication and dosage. A named duplicate should be kept in school for your child’s use. For safety reasons inhalers are kept by your child’s class teacher, which is accessible at all times. Your child needs to be trained to use their own inhaler as procedures do not allow staff to administer this medication. Your child will be supervised by an adult when taking their medication. Please complete and return the form below.

Name of child

Date of birth

Home address

Daytime contact telephone number

Mobile number

Name and Address of GP

Type of Inhaler prescribed

Date prescribed

Dosage

Expiry date

In the event of parents being unable to be located during an emergency, I give permission for a member of the school staff to take the necessary action.

I agree

Type name as signature (parent/guardian)

Click to confirm this as electronic signature

I confirm this acts as my signature

Date of signature

SCHOOL USE ONLY: Date form received on:

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Parkside Primary School

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