This form is not a substitute for the ASCIA Action Plan for Anaphylaxis or the Asthma Action Plan signed by the student’s doctor.

For some medications and some students it can be appropriate for them to carry their own medication to school and at school, for example, EpiPen® or Anapen® for anaphylaxis and asthma reliever medication for asthma.

For asthma and anaphylaxis it is important for students to have immediate access to their medication. Please consider whether your child should carry their own EpiPen®, Anapen® or asthma reliever medication to school and while they are at school.

On receiving this completed request form, the school will confirm the arrangements for how and where your child will carry their own medication.

You will still need to provide the school with at least one other EpiPen®, Anapen® and/or asthma reliever medication for storage in a central location/s within the school and for access by staff in case of an emergency.

If you would like the school to consider your request for your child to carry their medication, please complete the following information and return to:

Tracey Mullavey, SAM

Louise Purss-Semple, Principal

Request for student to carry their Asthma or Adrenaline Autoinjector medication

Holbrook Public School