2nd Grade to 6th Grade

09/30/2020

PATERSON CHARTER SCHOOL

FOR SCIENCE AND TECHNOLOGY 2-6

PATERSON CHARTER SCHOOL

FOR SCIENCE AND TECHNOLOGY 2-6

Food Allergy Plan Form

FOOD ALLERGY PLAN FORM
 
A Food Allergy Plan form only needs to be completed if your child requires an Epi Pen or benadryl liquid for any life-threatening allergies. It provides a doctor prescribed plan to the school nurse that details how to proceed should your child experience a mild or life threatening allergic reaction. 
 
Please make sure to have the doctor complete ALL portions, sign, and stamp the form where indicated. Also please make sure to sign the bottom of the form as well. BOTH signatures are required in order for the school nurse to administer these medications to your child. 
*If your child requires an Epi Pen or Benadryl in school, the epinephrine permission and physician order form must also be completed by the doctor and parent. Please refer to the Epinephrine Permission and Physician Order Form page. 
*A signed medication policy form is also required. Please refer to the Medication Policy Form page. 
 
Download link is at the bottom of the page. English and Spanish versions are available.

PCSST is an equal opportunity provider.