Online Training and Consent Form (Individualized Plan and Emergency Procedures for a Child with an Anaphylactic Allergy)-Trillium Bilingual Montessori
This mandatory form must be completed if a child has an anaphylactic allergy. This form must be completed in person with a member of the staff of TBM.
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Child's Name
First and Last Name
I, the parent/guardian of the child named above hereby confirm that:
a) I have trained the person (s) named in the Trainee Confirmation below on my child's Individualized Plan and Emergency Procedures on:
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b) I give consent to the person(s) named in the Trainee Confirmation below to train any other staff, students and volunteers who may be interacting with my child to perform the procedures detailed in my child's Individualized Plan and Emergency Procedures.
Trainee Information
This is the person who received training directly from the parent and who will train other staff members.
Name (First, Last)
Position at the School
Date
Training Was Received On this Day
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Signature of Trainee
This form will be signed in person, once training has been completed.
Date Signed
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/
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Parent/Guardian
This form will need to be signed once training has been completed.
Date Signed
MM
/
DD
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YYYY
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