Emergency Action Plans

Emergency Action Plans

If your child has a serious allergy or medical condition we require an up-to-date Emergency Action Plan.
All Emergency Action Plans (E.A.P) must include a picture of the student ulploaded directly to this form (refer section below) or appear in an Action Plan supplied to you by a Medical Practioner devised specifially for your child.
Child Name

First NameLast Name
Child Date of Birth

MonthDayYear
Date
Child’s Class, Time , Teacher, and which show/s they are performing in:
Parent / Guardian Name

First NameLast Name
Mobile Number
Email
example@example.com
Name of Condition
Explanation of the Condition and what medication may be required listing specific times. Please provide as much 'need to know' detail as possible:
Emergency Action Plan Required & Attached:

YES - Emergency Action Plan is attachedNO - Not Required
Emergency Action Plan (upload form here in pdf. or jpeg. format). Must be clear.

Epipens are to be dropped off to Green Room (rather than in bags)
Cancelof
Image of Child (upload a current image of your child here in pdf. jpeg. format only)

Cancelof
Should be Empty: