Asthma Information for Your Child's School

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:

Medicine______________­__________________________________________________

When? __________________________ How often?_____________________________

Medicine______________­__________________________________________________

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: ____________________