Consent to administer emergency inhaler

For Children Prescribed an Inhaler

We are required to renew the annual consent for the use of emergency inhalers kept in school. These are used only in emergencies, if a child’s personal device is unavailable or fails.

To provide or decline consent, please complete the form below.

Please complete the form even if you do not wish to give consent, as there is an option to indicate this.

Thank you for your continued support in helping us keep your child safe and healthy.

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Child's Full Name *

Please be advised the Walk to School Policy can be found on the policies page of this website.

Your relationship to the child *

Child's Year Group *

Nursery Reception Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

Address *

Post Code *

I can confirm that my child has been diagnosed with asthma and has been prescribed an inhaler. *

Yes

My child has a working, in-date inhaler, clearly labelled with their name, which they will bring with them to school every day *

Yes

In the event of my child displaying symptoms of asthma, and if their inhaler is not available or unusable, I consent for my child to receive salbutamol from an emergency inhaler held by the school for such emergencies *

Yes, I give consent No, I do not consent