Students with Asthma and Allergies

If your student has asthma, please sign and give this form to your child’s healthcare provider to complete and return to your child’s school. 

Asthma Care Plan

Use this form if your child carries an inhaler or epinephrine autoinjector in their backpack. Per Montana Code Annotated 20-5-420, parents/guardians are required to provide the school with a second epinephrine auto-injector, which will be kept in an accessible location in the school. Return completed and signed form to your child’s school. 

Consent to Carry and Administer Asthma & Allergy Medication

If your child needs their inhaler stored in the office and given with assistance/supervision, please sign and give this form to your child’s healthcare provider to complete and return to your child’s school. 

https://www.laurel.k12.mt.us/fs/resource-manager/view/0be9cba8-32b8-45c6-b7a3-d4655798b1ab

Please complete and sign this form if your child has a food allergy and prescribed epinephrine autoinjector. Your child’s healthcare provider should also complete and sign this form. Return completed and signed form to your child’s school. Please note there are two parts to this form. 

Anaphylaxis Emergency Care Plan Part 1

Anaphylaxis Emergency Care Plan Part 2

If your child carries an epinephrine autoinjector in their backpack, you must also complete the Montana Authorization to Carry and Self-Administer Asthma & Allergy Medication form. A health care provider must also sign this form. 

Consent to Carry and Administer Asthma & Allergy Medication