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Help prepare your child’s teachers and school nurse in case your child has an asthma attack at school. To do so, fill in your child’s information below. Be sure a copy of the filled-out form is given to your child’s teacher(s) and kept in the classroom. A copy should also be kept in your child’s file.
(Write your child’s name) _______________________________________ has asthma.
Things that can bring on an asthma attack: ___________________________
Signs that an attack may be starting: _________________________________
Medicines my child needs to take at school:
When? __________________________ How often?_____________________________
What my child should do before playing sports or before gym class:
Steps the teacher should take during an asthma attack:
Contact parent if attack continues.
Emergency names and numbers:
Name of parent(s): ___________________ Name of Doctor: ______________________
Telephone number: ___________________ Telephone number: ____________________
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