Inhaler Permission Form Emergency Salbutamol Inhaler Consent Please enable JavaScript in your browser to complete this form. Please enable JavaScript in your browser to complete this form. This is the consent form for the use of emergency Salbutamol inhaler in school. To be completed by all parents whose child has an inhaler in school. Child's Name: * Child's Class: * Child showing symptoms of asthma/having asthma attack my Name: an I can confirm that my child: *--- Select Choice --- has been diagnosed with asthma-like symptoms has NOT been diagnosed with asthma-like symptoms I confirm that my child: *--- Select Choice --- has been prescribed an inhaler has NOT been prescribed an inhaler In the event of my child displaying symptoms of an asthma attack, and if their inhaler is not available or is unusable. *--- Select Choice --- I consent for my child to receive salbutamol from an emergency inhaler held by the school for such emergencies. I DO NOT consent for my child to receive salbutamol from an emergency inhaler held by the school for such emergencies. If your child has been diagnosed with asthma and has been prescribed an inhaler, the school will require two working, in-date inhalers, clearly labelled with their name, which they will leave at school. If you have not yet provided these for the school please do so as soon as possible. Please ensure a separate consent form is completed for each child. If you do not consent to the use of a school inhaler, or have some concerns which you wish to discuss, please write to info@windleshamschool.co.uk Parent/Carer Signature Clear Signature Parent/Carer name * Parent / Carer Address: * Parent Email: * Home & Mobile Numbers: * Date * Submit
