Forms CLASS MedicalV2

Form type

Anaphylaxis: (Emergency Intervention Release)

Inhaler

Diabetes (Diabetes Hypoglycemia Emergency Action Plan)

Seizures

Other Information

Emergency Contact Information

Individual #1

Individual #2

Submitted by I acknowledge that transportation procedures will apply.

Authorization for the collection of this information is in the Education Act. Users will be the Principal, Teacher, School Bus Operator, School Bus Driver, School Bus Attendant and appropriate school support staff for the purpose of obtaining parental consent and direction for life-threatening situations. This form will be retained in the school office for as long as is deemed necessary. Contact person for queries concerning this information is the Principal of the school

And, I hereby release the school bus operator, school bus driver, school bus attendant and Chatham-Kent Lambton Administrative School Services (CLASS) and each of their respective employees, officers and agents from any liability in the same manner as provided in Section 3, subparagraph (4) of Sabrina's Law, 2005, S.O. 2005, Chap. 7 which provides “No action for damages shall be instituted respecting any act done in good faith or for any neglect or default in good judgment in response to an anaphylactic reaction in accordance with this Act, unless the damages are the result of an employee's gross negligence”, it being specifically agreed by me that any act done or not in furtherance of the instruction given herein should have the same protection as extended to school board employees by Sabrina's Law.


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