Asthma, Anaphylaxis and Allergies Plans

Asthma, Anaphylaxis and Allergies Plans

Please provide your child's asthma, anaphylaxis and allergies management information and upload the relevant action plans.
Please attach a photo of your child to the plan — this is very important.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Asthma, Anaphylaxis and Allergies
Please list your child's known triggers (e.g., foods, environmental factors, exercise):
Please list your child's current medications for asthma and/or anaphylaxis, allergies:
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Upload your child's Asthma, Anaphylaxis, Allergies Action Plans

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Upload a current photo of your child

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Your plan will be given to your child's room leader. All medication will be kept in the kitchen downstairs. Please label and place all medication in a suitable carry case, and hand it to the check-in staff on arrival to the theatre for storage.
Should be Empty: