Allergy and Anaphylaxis Emergency Plan

Use this form if your child has a life-threatening allergy to something OTHER THAN bee stings. Examples include food allergies (peanuts, shellfish), contact allergies like Latex, or medication allergies like Penicillin. Again, this form needs to be completed by a parent/guardian and a physician/health care provider, and needs to be accompanied by a Permission to Self Carry form if the student is planning on carrying an Epi pen, as well as the Prescription Medication Form for the Epi pen.