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Grammar School for Boys
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Grammar School for Boys
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AAI Form
AAI Form
Parental Permission to use School Emergency Adrenaline Auto Injector (AAI) Kit
This may be an EpiPen, Jext or other AAI brand
Student First name:
*
Please enter
*
Which school year is your child currently in?
*
7
8
9
10
11
12
13
Registration Group e.g. (7OL)
*
I can confirm that my child has been diagnosed as being at risk of anaphylaxis and has been prescribed an adrenaline auto injector (AAI).
*
Yes
No
My child has a working, in-date AAI, clearly labelled with their name, which they will bring with them to school every day.
*
Yes
No
In the event of my child displaying symptoms of anaphylaxis, and if their AAI is not available or is unusable, I consent for my child to receive adrenaline from an Emergency AAI held by the school for such emergencies.
*
Yes
No
Parent/Guardian Name
*
Contact Telephone Number:
*
Email address:
*
Submit
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