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Life Threatening Allergies

Allergy Collage

A student with a physician's documented life threatening allergy requiring the emergency administration of epinephrine will need to complete the following forms. Additionally, N.J.S.A. 18A:40-12.5 and 12.6 was adopted because a school nurse may not be physically present at the scene to assess an allergic reaction and administer epinephrine to pupils who cannot administer the medication themselves. The law permits the School Nurse, in consultation with the Evesham Township Board of Education, to designate another employee of the district to administer epinephrine to a pupil with a history of anaphylaxis. Written medical orders from a physician as well as a signed parental form are required in order to administer any medications at school. Please have your physician complete the forms which can be downloaded from this page. The medication should be brought to the school by the parent/guardian before the first day of school. Please contact me at 856-988-9811 (#8604) if you have any questions regarding your child's allergy.

Click below to download forms:

EPI-Pen Order Form

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