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Altrincham
Grammar School for Boys
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Grammar School for Boys
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Asthma & Inhaler Users
Parental Permission to use School Emergency Inhaler Kit
This will be the Blue inhaler (Salbutamol)
Student First name:
*
Student Surname:
*
3. Which school year is you child currently in?
*
7
8
9
10
11
12
13
Registration Form: eg. (7OL)
*
I can confirm that my child has been diagnosed with Asthma and has been prescribed an inhaler.
*
Yes
No
My child does not have Asthma but uses a blue inhaler for other medical purposes (Please detail below)
*
My child has a working, in-date inhaler clearly labelled with their name, which they will bring with them to school everyday.
*
Yes
No
In the event of my child displaying symptoms of Asthma (or other related breathing difficulties detailed above), and if their inhaler is not available or is unusable, I consent for my child to receive Salbutamol from an Emergency inhaler pack held by the school for such emergencies.
*
Yes
No
Parent/Guardian Name:
*
Contact Telephone Number:
*
Email address:
*
Submit
In this section
Asthma & Inhaler Users
Medical Conditions
Expression of Interest Form
Residential Trip Application Form
Day Trip application form
