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Pelham Memorial School


Asthma Care Plan
This is a care plan that you and the doctor need to fill out if your child is going to be using an inhaler at school.
Bee Sting Allergy Emergency Care
This is the first page of the Bee sting allergy Emergency care plan. This needs to be filled out by you and the doctor.
Food Allergy & Anaphylaxis Emergency Care Plan
Use this form to document a plan for your child in case of a severe allergic reaction.
Parent Request to Give Medicine
Parents may fill out this form if their child needs to have over the counter medications during the school day. Examples would be tylenol, ibuprofen, cough drops. Parents must supply the medication in the original bottle and students cannot transport medications. Adults must transport the medication.
Grade 1 to 12 Permission to Carry
This is the permission form that needs to be signed by you, the doctor, the student and myself in order for your child to carry an EPIPEN and or an inhaler around with them in school.
Physician Physical Form
This form may be used by the physician for the physical exam. We also accept forms from the physician office.

Last Updated: Wednesday, January 30, 2019 8:30AM


There will be a 2 hour delay on Wednesday, January 30.
No AM kindergarten or preschool.