Asthma - Emergency Action Plan

Problems With Medications
Signature and Understanding
I understand and agree that per WVDE Medication Policy 2422.8:
1. I (or an adult delegate) must deliver all medication to the office and sign it in on the medication log.
2. Agree never to send the medication with my child.
3. Agree to supply refills in a prompt manner when notified, to avoid missed doses.
I understand and agree that information in this Emergency Action Plan will be shared with appropriate school staff.
Are you able to provide your signature on this form?

Yes, I am able to provide my signature on this form.No, I am NOT able to provide my signature. Note: You will need to come to the school and sign in-person.
Parent / Guardian Signature

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