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School Asthma Card

To be filled in by the parent/carer

This card is for your child’s school. Review the card at least once a year and remember to update or exchange it for a new one if your child’s treatment changes during the year. Medicines and spacers should be clearly labelled with your child’s name and kept in agreement with the school’s policy.

Fields marked with an * are required

School Asthma Card

Child's name *(Required)

Date of Birth

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Parent/carer's name

First Last

Telephone - home

Telephone - mobile

Doctor/nurse's name

Doctor/nurse's telephone

Reliever treatment when needed

For shortness of breath, sudden tightness in the chest, wheeze or cough, help or allow my child to take the medicines below. After treatment and as soon as they feel better they can return to normal activity.

Medicine

Parent/carer's name

First Last

Parent/carer's consent

Yes

If the school holds a central reliever inhaler and spacer for use in emergencies, I giver permission for my child to use this.

Date