Form 317-1 Medical Alert Information AP 317 Allergy (Anaphylaxis) Reference Management Insert School Name, Revised July 29, 2013 Address, Town, Sask., Postal Code Phone: (Number) Fax: (Number) Level School email address if applicable Submit to Principal When Beginning of Year (Insert student picture) Student Information Student Name Room Number Symptom(s)/Allergy Treatment Parent/Guardian Contact Information Parent/Guardian Name Phone Number (home) Phone Number (work) Cell Number Alternate Contact Information (If parent/guardian not available) Alternate Contact Name (home) Phone Number Phone Number (work) Cell Number
Form 317-1 Medical Alert Information Insert School Name, Address, Town, Sask., Postal Code Phone: (Number) Fax: (Number) email address if applicable Reference AP 317 Allergy (Anaphylaxis) Management Revised July 29, 2013 Level School Submit to Principal When Beginning of Year (Insert student picture) Student Information Student Name Room Number Symptom(s)/Allergy Treatment Parent/Guardian Contact Information Parent/Guardian Name Phone Number (home) Phone Number (work) Cell Number Alternate Contact Information (If parent/guardian not available) Alternate Contact Name Phone Number (home) Phone Number (work) Cell Number