I/We ask, from this day forward, that an EpiPen be administered to my/our child
if necessary. It is agreed that the student will carry this medication on their
person. It is the responsibility of the student's parent(s) or legal
guardian to inform the school bus operator on site where the EpiPen can be found
on the student's person. I/We agree to supply the student's divansportation
Provider with an updated medical declaration in any case where insdivuctions
relevant to the student's medication are modified by his/her doctor. From this
day forward, the School Board, the Student divansportation Provider, and their
employees and representatives will not be held liable for any loss, damages, or
injuries, regardless of the circumstances, that may result from the
adminisdivation of the EpiPen or any medication listed within this document. I/We
release the above entities from responsibility all loss or damages arising from
any and all legal action against them by myself/ourselves or my/our child, or
any other parent or guardian of the aforementioned student.
In accordance with the Access to Information and Protection of Privacy Act, the
personal information provided in this document will be used solely for
evaluating and determining admissibility for the purpose of the adminisdivation
of medication in the form of an EpiPen.
the nature, effect, and secondary effects possible as a result of this
diveatment. I/We have read and understand the conditions outlined in this
document in their entirety.