

2026-2027 Back to School Guide

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2026-2027 Back to School Guide

Dear Members of the Rowntree Community,
I hope you and your family are enjoying a wonderful and well-deserved summer. As we look ahead to the 2026–2027 school year, I am pleased to share next year ' s school calendar, along with important information to help you prepare for a successful start to September
As I begin my role as Interim Head of School, I want to express how excited I am for the year ahead. Summer is an important time of planning and preparation across our campuses, and our dedicated team is already hard at work getting everything ready to welcome our students back From preparing classrooms and enhancing learning spaces to welcoming new staff and students, every effort is focused on ensuring a positive and engaging start to the school year.
The coming year promises many exciting opportunities for our students to continue to learn, grow, and thrive Whether through academics, leadership, athletics, the arts, or meaningful community experiences, we remain committed to fostering an environment where every child is challenged, supported, and inspired to reach their full potential Our goal is to nurture not only academic excellence but also the confidence, character, and curiosity that will serve our students well throughout their lives.
One of the greatest strengths of our school is the partnership we share with our families I look forward to working closely with you throughout the year as we continue to build a caring, inclusive, and vibrant school community where every child feels valued and supported. Throughout the summer, please continue to watch your email for important updates as we prepare for September. Later this summer, you will also receive our Parent/Student Handbook, which will include key information, school policies, and helpful reminders for the upcoming school year
Warm regards,
I hope you enjoy a restful and memorable summer with your family and friends. We look forward to welcoming both our returning and new families back to campus this September and beginning another exceptional year together Mrs. Emina Tihak
Interim Head of School
First Day of School
Professional Development Day (no class)
Thanksgiving Holiday (no class)
Professional Development Day (no class)
Last day of classes before Winter Break
Holiday Break (no class)
School Resumes
Professional Development Day (no class)
Family Day Holiday (no class)
Professional Development Day (no class)
March Break (no class)
Good Friday (no class)
Easter Monday (no class)
Professional Development Day (no class)
Professional Development Day (no class)
Victoria Day Holiday (no class)
Last Day of School
SEP 8, 2026 (Tue)
OCT 9, 2026 (Fri)
OCT 12, 2026 (Mon)
NOV 6, 2026 (Fri)
DEC 18, 2026 (Fri)
DEC 21, 2026 - JAN 1, 2027 (Mon-Fri)
JAN 4, 2027 (Mon)
FEB 12, 2027 (Fri)
FEB 15, 2027 (Mon)
MAR 5, 2027 (Fri)
MAR 15 -19, 2027 (Mon-Fri)
MAR 26 2027 (Fri)
MAR 29, 2027 (Mon)
APR 16, 2027 (Fri)
MAY 21, 2027 (Mon)
MAY 24, 2027 (Fri)
JUN 23, 2027 (Wed)
School begins on Tuesday, September 8, 2026, at 8:40 a m sharp
Parents, to beat the rush closer to the start of the school year, please take notice that you can buy your child’s uniform from InSchool Wear online at www inschoolwear com with the shopping code: rtms or in person at their store at 5359 Timberlea Blvd, Unit 54, Mississauga, ON L4W 2R7 All Grade 6 and 8 students require a blazer as part of their uniform Please be advised that students are to arrive in full uniform on the first day of school Please check the store’s website for store hours and how to make an appointment
Be sure to have all the articles for your children’s specific grades as indicated on the attached School Supplies List for the start of the school year Also, please ensure all items are labelled with your child’s name
All Grade 1-8 students are to order textbooks from www.alphatextbooks.com. You must order all books listed for each Grade under the school name The textbooks will be delivered directly to your door It is assumed that students will arrive at school on the first day with all of their required textbooks for the year
Parents who have signed up for Pre-Authorized Debit to pay tuition fees: The first withdrawal from your bank account will be August 3, 2026

General writing materials must be brought into class on the first day of school and may need to be replenished throughout the year Teachers may request additional materials
All belongings must be clearly labelled with your child’s name. RMS is not responsible for lost items
1 Large Ziploc Bag Containing A Change Of Clothes
1 Pack Of Sharpened Pencils - 12 Pack
2 Erasers (Only White)
1 Pencil Sharpener With A Shaving Catcher
3 Packs Of Crayons - 24 Pack
1 Pack Of Pencil Crayons - 24 Pack
2 Packs Of Washable Markers
1 Pair Of Scissors (Child-Safe)
5 Glue Sticks
3 Bottles Of Liquid Glue
2 Soft Pencil Cases To Contain The Above
1 Auxiliary, Not A Bluetooth Headset
3 Exercise Notebooks - 80 Pages
5 Folders With Pockets (No Prongs)
1 Block Of Construction Paper
3 Sketchbooks For Free-Time Drawing
1 School-Size Backpack For Everyday
1 White Three-Ring Binder 1.5"
1 Pack of dividers
12 HB #2 Pack Of Sharpened Pencils
2 Packs Of Pencil Crayons - 24 Pack
1 Pack Of Crayons - 24 Pack
1 Pack Of Washable Markers - 12 Pack
2 Erasers
4 Glue Sticks
1 Bottle Of Liquid Glue
1 Pair Of Scissors (Child-Safe)
2 Soft Pencil Cases To Contain The Above
1 Auxiliary, Not A Bluetooth Headset
3 Stapled, Not Spiral-Bound Exercise Notebooks - 80 Pages
3 Folders With Pockets
1 Pack Of Construction Paper
1 Sketchbook For Free-Time Drawing
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Ruler - 30 cm
1 Ruler - 12 cm
2 Packs Of Sharpened Pencils
2 Packs Of Pencil Crayons (12 Or 24 Packs)
2 Packs Of Crayons
2 Packs Of Markers
5 Erasers
2 Sharpeners
4 Glue Sticks
1 Bottle Of Liquid Glue
1 Pair Of Scissors (Child-Safe)
2 Pencil Cases, Not Hard Plastic, Preferably A Fabric Pencil Case
1 Auxiliary, Not A Bluetooth Headset
1 Construction Paper Book
2 Sketchbooks For Free-Time Drawing
1 80-Page Stapled Exercise Notebooks (Not Spiral-Bound)
1 One-Centimetre Square Grid Composition Notebook (Graph Paper Book)
6 32-Page Exercise Notebooks
6 Three-Prong Duotang With Pockets
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 32-Page Blue Exercise Notebook (French)
1 Three-Prong Duotang With Pockets (French)
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Ruler - 30 cm
2 Packs Of Pencil Crayons
1 Pack Of Markers
3 Packs Pre-Sharpened Pencils - 12 Pack
5 Erasers
2 Sharpeners With A Shaving Catcher
3 Glue Sticks (Preferably Large)
1 Bottle Of Liquid Glue
1 Pair Of Scissors (Child-Safe)
2 Pencil Cases To Contain The Above
1 Auxiliary, Not A Bluetooth Headset
1 Construction Paper Book
2 Sketchbooks For Free-Time Drawing
8 80-Page Stapled Exercise Notebooks (Not Spiral-Bound)
1 One-Centimetre Square Grid Composition Notebook (Graph Paper Book)
1 40-Page Exercise Notebook
6 Three-Prong Duotang With Pockets
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 32-Page Exercise Notebook (Music )
1 32-Page Blue Exercise Notebook (French)
1 Three-Prong Duotang With Pockets (French)
1 15 cm Ruler
1 30 cm Ruler
1 Protractor
4 Pack Sharpened Pencils - 12 Pack
2 Packs Of Pencil Crayons - 12 Pack
1 Pack Of Markers - 12 Pack
4 Erasers
2 Sharpeners With A Shaving Catcher
4 Glue Sticks
2 Bottles Of Liquid Glue
1 Pair Of Scissors (Child-Safe)
2 Pencil Cases To Contain The Above
1 Mouse For Chromebook
1 Auxiliary, Not A Bluetooth Headset
1 Pack Of Coloured Paper
1 Sketchbook for Free-Time Drawing
8 Stapled, Not Spiral-Bound Exercise Books - 80 Pages
2 Stapled, Not Spiral-Bound Exercise Books - 40 Pages
3 One-Centimetre Square Grid Composition Notebook (Graph Paper Book)
4 Three-Prong Duotang With Pockets (Preferably Red, Blue, Yellow, And Green)
1 Three-Prong Duotang With Pockets (Preferably Black)
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 32-Page Exercise Notebook (Music)
1 40-Page Blue Exercise Notebook (French)
1 Three-Prong Duotang With Pockets (French)
1 15 cm Ruler
1 30 cm Ruler
1 Protractor
1 Pack Of Sharpened Pencils - 12 Pack
1 Pack Of Pencil Crayons - 12 Pack
1 Pack Of Highlighter Pens
1 Pack Of Erasers - 3 Pack
2 Sharpeners With A Shaving Catcher
4 Glue Sticks
1 Pair Of Scissors
2 Small Pencil Cases To Contain The Above
2 Age-appropriate novels of choice for free-time reading
1 Chromebook Mouse (Optional)
1 Set Of Headphones
2 Bright, Colourful Cardstock Paper Packs
2 Sketchbooks For Free-Time Drawing
4 Stapled, Not Spiral-Bound Exercise Books - 80 Pages ( Pink)
2 Stapled, Not Spiral-Bound Exercise Books - 80 Pages ( Green)
2 Stapled, Not Spiral-Bound Exercise Books - 80 Pages ( Yellow)
2 Stapled, Not Spiral-Bound Exercise Books - 80 Pages ( Blue)
1 Stapled, Not Spiral-Bound Exercise Book - 40 Pages
5 One-Centimetre Square Grid Composition Notebook (Graph Paper Book)
4 Three-Prong Duotang With Pockets (Pink-1, Green-1, Yellow -1, Blue-1)
3 Three-Prong Duotang With Pockets (Plastic)- Red
1 Sketchbook - 8.5"11" Sketchbook, 100 Sheets (Art)
1 32-Page Exercise Notebook (Music)
1 80-Page Blue Exercise Notebook (French)
1 Three-Prong Duotang With Pockets (French)
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Transparent Standard Ruler 30 cm
1 Oxford Geometry Set
2 Packs Of Sharpened Pencils - 12 Pack
1 Each Of Coloured Erasable Pens (Black, Blue, Red)
1 Pack Of Pencil Crayons - 24 Pack
1 Pack Of Markers - 12 Pack
3 Fine-Tip Black Markers ( Permanent And Dry-Erase)
4 Erasers
2 Sharpeners With A Shaving Catcher
5 Glue Sticks
1 Pair Of Craft Scissors
2 Pencil Cases (Soft Cloth)
1 Three-Dial Combination Lock (No Luggage Locks)
3 Age-appropriate physical novels of choice for free-time reading
1 Set Of Headphones
2 16” By 24” Canvas
2 Bright, Colourful Cardstock Paper Packs
1 Ring-Bound Sketchbook (9” X 12”) - 50 Pages
2 Sketchbooks For Free-Time Drawing
10 Stapled, Not Spiral-Bound Exercise Books - 80 Pages
2 Stapled, Not Spiral-Bound Exercise Book - 40 Pages
5 One-Centimetre Square Grid Composition Notebook (Graph Paper Book)
5 Three-Prong Duotang With Pockets (Red, Blue, Green, Yellow, Black)
1 White Three-Ring Binder 1.5"
1 Pack of dividers
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 32-Page Exercise Notebook (Music)
1 80-Page Blue Exercise Notebook (French)
1 Ruler in cm
1 Geometry Set
1 Pack Pencils - 12 Pack
1 Pack Of Sketch Pencils - 6 Pack
1 Pack Of Colouring Materials (Either A Set Of Pencil Crayons Or Markers)
3 Glue Sticks
1 Three-Dial Combination Lock (No Luggage Locks)
1 Scientific Calculator
1 Set Of Headphones
2 Age-appropriate physical novels of choice for free-time reading
1 Pack Of Graph Paper
1 Pack Of Lined Paper
1 Pack Of Blank Paper
10 Stapled, Not Spiral-Bound Exercise Books - 80 Pages
1 Stapled, Not Spiral-Bound Exercise Book - 40 Pages
4 Graph Notebooks
1 Three-Prong Duotang With Pockets
1 Three-Prong Duotang With Pockets (Plastic)
1 White Three-Ring Binder 1 5"
1 Pack of dividers
1 Sketchbook - 8.5"11" Sketchbook, 100 Sheets (Art)
1 Watercolour Paper Pad (4x6 Or 5x7) (Art)
1 Watercolour set of 12 colours (Art)
1 32-Page Exercise Notebook (Music)
1 80-Page Blue Exercise Notebook (French)
1 Ruler in cm
1 Geometry Set
1 Pack Pencils - 12 Pack
1 Pack Of Sketch Pencils - 6 Pack
1 Pack Of Colouring Materials (Either A Set Of Pencil Crayons Or Markers)
2 Glue Sticks
1 Three-Dial Combination Lock (No Luggage Locks)
1 Scientific Calculator
1 Set Of Headphones
2 Age-appropriate physical novels of choice for free-time reading
1 Pack Of Graph Paper
1 Pack Of Lined Paper
1 Pack Of Blank Paper
9 Stapled, Not Spiral-Bound Exercise Books - 80 Pages
1 Stapled, Not Spiral-Bound Exercise Book - 40 Pages
4 Graph Notebooks (Math)
1 Three-Prong Duotang With Pockets
1 Three-Prong Duotang With Pockets (Plastic)
1 White Three-Ring Binder 1.5"
1 Pack of dividers
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 Watercolour Paper Pad For Art Classes (4x6 Or 5x7) (Art)
1 Watercolour set of 12 colours (Art)
1 Ruler
1 Geometry Set
12 Pencils
1 Pack Of Sketch Pencils - 6 Pack
12 Pens
1 Eraser
1 Pack Of Colouring Materials (Either A Set Of Pencil Crayons Or Markers)
2 Glue Sticks
1 Pair Of Scissors
1 Three-Dial Combination Lock (No Luggage Locks)
1 Scientific Calculator
1 Set Of Headphones
1 Pack Of Construction Paper
1 Pack Of Lined Paper (Pack Of 100)
1 Pack Of Blank Paper
13 Stapled, Not Spiral-Bound Exercise Books - 80 Pages
4 Graph Notebooks ( Math)
1 Three-Prong Duotang With Pockets
1 Three-Prong Duotang With Pockets (Plastic)
1 White Three-Ring Binder 1.5"
1 Pack of dividers
1 Sketchbook - 8 5"11" Sketchbook, 100 Sheets (Art)
1 Watercolour Paper Pad For Art Classes (4x6 Or 5x7) (Art)
1 Watercolour set of 12 colours (Art)
3709 Chesswood Drive, Toronto, Ontario, M3J 2P6
416-461-3542 | 1-877-632-5742
info@alphatextbooks com
Your official booklist will be available on our easy-to-use website www alphatextbooks.com, or at their store. For convenience, we recommend you to order online
To order from our website, simply click the red “Students Order Here” button on the homepage You will be asked to sign in or create a new account Your account allows you to see your order history and your order status Follow the instructions to create a new account Ensure you select your school Then verify your new account by clicking the link in the email you will immediately receive
Once your account is verified, sign in Select Rowntree Montessori School and grade from the drop-down menu and select your books You can review your order by clicking on the shopping cart at the top of the page Follow the instructions to enter your shipping and billing info You may opt to pick up your books in our store, which will remove any shipping charges Click “Place Order” to complete your order.
If you select store pick-up instead of shipping, please wait for the completion email stating your order is ready for pick-up We strongly encourage you to pick up your order within 7 days. Our address is 3709 Chesswood Drive (Sheppard Ave W & Allen Rd is the nearest intersection).
Books may be returned for a full refund up to September 30, 2026. E-texts are not returnable Books must be returned in the same condition in which they were purchased. Please, do not write your name, stamp, or sticker anything in your book Books returned after September 30th may be subject to a restocking fee

Code
Knitwear (various Style options)
7501
7521
Green Crested Knit Cardigan
Green Crested V-Neck Knit Sweater
Formal Shirts (various Style options)
5060 5040
White Short Sleeve Formal Shirt
White Long Sleeve Formal Shirt
Navy Pants (various Style options)
2010 2030 Navy Boys Junior Pant
Navy Boys Adjustable Pant
RTM Tartan Tie (various Style options)
11” - 17”
11” - 17”
Age:1/2 - 12/13
-
Code
Navy Ribbed Socks
Green Crested V-Neck Knit Vest
Navy Essex Shorts
1028 Green Crested ECO Blazer
Formal Shirts (various Style options) 5060 5040 White Short Sleeve Formal Shirt White Long Sleeve Formal Shirt
Adjustable
Navy Adjustable Walking
Adult Regular Tie
Navy Ribbed Socks
Code
7501 Green Crested Knit Cardigan Chest: 24” - 34”
Formal Shirts (various Style options) 4024 6050 6040 White Crested Short Sleeve Polo
White Short Sleeve Katie Collar Blouse
White Long Sleeve Katie Collar Blouse
2 - 7/8
- 44”
Navy Crested Side Pleated Tunic
Navy Knee High Socks
Navy Tights (Youth)
2 - 14 Shoe Size
4/6 - 6/8
Navy Junior Pant
3/4 - 12/13
Code
Knitwear (various Style options)
7501
7521
Green Crested Knit Cardigan
Green Crested V-Neck Knit Sweater
Formal Shirts (various Style options)
6050 6040
Code Description Description
White Short Sleeve Katie Collar Blouse
White Long Sleeve Katie Collar Blouse
Chest: 24” - 40”
Chest: 24” - 40”
Chest: 22” - 44”
Chest: 22” - 44”
2535 9510 8010 8520 8510 2083 2080
Navy ECO Skort
Navy Floppy Bow Tie
Navy Knee High Socks
Navy Tights (Youth)
Navy Tights (Adult)
Age: 3/4 - 11/12 One Size Shoe
Navy Junior Pant
Navy Adjustable Pant
3/4 - 12/13
4 - 16
26” - 42”
Code
Green Crested ECO Blazer
Blackwatch Tartan Kilt
Formal Shirts (various Style options)
Chest: 26” - 40”
Age: 6 - 16
Adult Small - 2XL
6030 6020 White Short Sleeve Katie Collar Blouse Chest: 22” - 468”
2080 Description
White Long Sleeve Katie Collar Blouse Chest: 22” - 46”
Navy Adjustable Pant (Winter)
RTM Tartan Tie (various Style options)
9510 9540 9560 Navy Floppy Bow Tie Junior Regular Tie Adult Regular Tie
54” Age: 6 - 16 Waist: 26” - 42”
Navy Knee High Socks
Navy Tights (Adult)
Shoe Size
Adult Small - XL
(various Style options)

We know that this policy will not only set guidelines for parents, administrators and teachers but will also make the parents feel more secure regarding the policy that RMS follows Your child(ren)’s safety is very important to us With this treatment plan, we make sure that all parties involved know what their responsibilities are and what is expected of them in the administering of the EpiPen ® . In order to comply with the obligations, we request that you read the information carefully, complete it and return the form found in the link below, with 2 Epi-Pens labelled with your child’s name to the school.
The completed form and the two EpiPens should be handed in to the school’s office no later than September 4
RMS provide a ‘Minimized Allergen Environment’ for children with life threatening allergies It is NOT possible for the school to totally eliminate the risk of your child coming in contact with a life threatening allergen in the school environment and/or at off site locations (e.g. field trips).
The school’s emergency treatment plan in the event of exposure to a life threatening allergen as recommended by Anaphylaxis Canada is as follows
A.C.T.:
A Administer the Epipen immediately the child displays any of the anaphylactic symptoms * C Call 911
T. Transport the child by ambulance to hospital even if symptoms subside.
*The school does not have the facilities nor the qualified personnel to ’wait and see’ if the symptoms get worse or administer antihistamines or asthma medication etc prior to administering the EpiPen
“SABRINA’S LAW” - An Act to protect anaphylactic pupils
Excerpts:
Obligation to keep a school informed:
(1.1) It is the obligation of the pupil’s parent or guardian and the pupil to ensure that the information in the pupil’s file is kept up-to-date with the medication that the pupil is taking
6 The pupil’s file must contain: ‘ a copy of the prescription and instructions from the pupil’s physician or nurse and a current emergency contact list.’
To comply with the above obligations we request that you complete and return the forms found in this package to the school administrator DURING THE LAST WEEK OF AUGUST or if registering during the school year as soon as possible (no more than a week):
Request and consent for the administration of epinephrine form
Proof of diagnosis which can be one of:
a copy/photocopy of the prescription; photocopy of the prescription from the Epi Pen container; a copy/photocopy of the Official Receipt of the medication from the pharmacist;
a letter/note from the physician or allergist
This form contains the child’s photograph, information about the child’s allergy, emergency contact numbers and emergency protocol and signature of parent/guardian. Pictures should be recent photographs of the head and shoulders, approx 2”x3”
(To identify your child to others these forms will be posted in the staff room/health room and/or where appropriate in the classroom (parent permission) and in the Occasional Teacher folder At elementary schools the form will be provided to the bus driver, if your child takes a bus )
Please Note
In order that the school complies with the legislated requirements of providing a safe environment for your child, you are strongly encouraged to provide all relevant information and forms about your child’s life-threatening allergy to the Head of School in a timely manner (i e for students already registered the last week of August, for newly registered or diagnosed students no more than one week) Failure to do so may place your child at unnecessary risk
Please provide your child with - EPI PENS (The Twinjet delivery system has a syringe injection when administering the second dose.) As a result, Epi Pens are the choice of Rowntree Montessori Schools
1. The students from grades PreKM to Grade 8 are to have one stored in the first aid bin in the classroom Epi Pen should be in a protective container labeled with the child’s name.
2 The second Epi Pen will be stored in the school office in a secure, accessible but not locked location in case a second injection is required
In order that the school complies with the legislated requirements of providing a safe environment for your child, you are strongly encouraged to provide the medication (epinephrine auto injectors) in a very timely manner (i e , when the child is attending school) Failure to do so may place your child at unnecessary risk
Parents are responsible to keep track of the expiry dates of their child’s Epi Pens and for providing a current Epi Pen when the old one expires.
Parents are responsible to keep the school up to date with any change of information, diagnosis, medication etc as soon as reasonably possible If your child has outgrown their allergy or no longer is diagnosed with anaphylaxis please obtain a letter from your physician/allergist and provide this letter to the Head of School
Provide for a Medical Alert Identification for your child Where possible provide your child with allergen free food products when requested for activities and special events
To understand their allergy and identify the substances that may trigger a reaction
Recognize the signs and symptoms of an allergic or anaphylactic reaction
Inform a responsible adult immediately if they feel unwell, suspect exposure to an allergen, or notice symptoms beginning
Know where their epinephrine auto-injector (EpiPen) is located at all times
Wear or carry their MedicAlert identification whenever possible.
Eat only foods approved by their parent/guardian and avoid consuming food from unknown sources.
Never share food, snacks, lunches, drinks, utensils, containers, or other food-related items with others.
Use a clean barrier, such as a placemat, between their food and eating surfaces when appropriate.
Practice proper handwashing before and after eating
Advocate for themselves by informing peers, staff, caregivers, and other adults about their life-threatening allergy
Report any teasing, bullying, or unsafe behaviour related to their allergy to a trusted adult
Notify a friend, teacher, or responsible adult immediately if accidental exposure occurs or if they begin experiencing symptoms.
Resist peer pressure that may compromise their safety and make responsible choices regarding allergy management.
Stay with others and seek adult assistance if feeling unwell or experiencing symptoms; never go to the washroom or another area alone, as symptoms can worsen quickly and may prevent them from being able to call for help
Know where your epinephrine auto-injector is in the classroom.
Know how to self-administer your epinephrine auto-injector
Carry/wear your Medic Alert identification at all times.
Have an age-appropriate understanding of your life-threatening allergy, its triggers, the symptoms of an anaphylactic reaction, how to administer an Epi Pen, and how to access assistance from an adult in authority.
Select a friend (buddy) whom you can advise if a reaction is occurring and who can get help when necessary from an adult in authority
Promptly inform a responsible adult that you have a life-threatening allergy as soon as accidental exposure occurs, symptoms appear, or when experiencing a general feeling of unwellness
Eat lunch with friends who are informed about your allergy and are able to help you if you have a reaction. These friends would know the location of your auto injector and be age-appropriate when and how to use it.
Comply and assist, where possible, the administration of the autoinjector from an adult in authority. Avoid hazardous allergens.
For food allergies - eat only food items approved by parent/guardian. No trading or sharing of foods, food utensils and food containers
Do NOT eat foods other than your own if you do not have your Epi Pen For allergies to bee stings/latex, etc , do a check of your environment first to ensure harmful allergens are not present before participating in activities
Wash hands on a regular basis especially before and after eating
Do NOT go off alone (e.g., to the washroom) when experiencing an allergic reaction or feeling unwell No one to assist if you lose consciousness. Report to a responsible adult any and all occurrences of teasing, bullying, or threats related to your allergy
This form is completed when the school agrees with the parental request to administer medication for life-threatening allergies A new form is required: a) at the initiation of this process; b) at the beginning of the school year; c) when the medication changes Staff agreeing to administer medication will do so according to the information on this form only
Date:
Student Name:
Address:
Date of Birth:
Student #:
Grade:
Name of Mother: Phone:
Name of Father: Phone:
Name of Guardian: Phone:
Emergency Contact: Phone:
Room:
Gender:
Medical ID:
Teacher:
(dd/mm/yy)
Regarding Parent Requests to provide Prescribed Medication (Epinephrine) to students by Employees of the School Board.
As the Parent(s)/Guardian of(print name of student)_____________ , I (we) accept and endorse the following five terms and/or conditions pertaining to my(our) request for School Board employees to provide my(our) child with the epinephrine prescribed under the authority and supervision of the doctor named in Part C of this form. Specifically, I/we understand and accept that:
1 I/we are responsible for providing and maintaining two Epinephrine auto injectors One to be stored in the classroom Other to be stored in a secure and accessible location in the office
2 I/we are responsible for providing a copy of the prescription and instructions from the child’s physician or nurse for my(our) child’s file (Please note: Where there has been no change in the child’s condition or treatment strategy from the previous year, parents may authorize continuation of the Anaphylaxis Emergency Treatment Plan without proof of diagnosis ‘ copy of the prescription’ - with initials below )
3 School employees are not trained health professionals and hence may not recognize the symptoms of my(our) child’s medical condition I/we realize that the school does not have the facilities nor the qualified and trained health professionals to ‘wait and see’ what happens before administering the Epinephrine autoinjector
4 The Emergency Action plan following the best advice from Anaphylaxis Canada is to:
A Administer the auto-injector immediately at the first sign of symptoms;
C Call 911
T Transport to hospital by ambulance
5. Epinephrine auto-injectors supplied to the school will be in clearly labeled containers which display
a) name of your child
b) name of prescribing doctor, and;
c) expiry date
Signature: Date:
There has been no change in condition or treatment strategy from previous year Parent initial:
Name of child’s physician/allergist: Contact Number:
Child’s Life Threatening Allergens (please list):
Please outline how the allergen(s) has to come in contact with your child in order to trigger an anaphylactic reaction (e g ingestion, physical contact with hands, face; other):
Prescribed Medication:
Additional instructions as needed:
Insofar as it concerns my/our child (print child’s full name a student attending RMS I/we:
have read and understand the information conveyed in this “Request and Consent for the Administration of Epinephrine” form; agree to comply with the responsibilities described in Part B above; request that the medications listed in Part C of this form be administered to my child according to the prescription information provided by the prescribing physician
Signature:
Date:
Student Name:
THIS PERSON HAS POTENTIALLY LIFETHREATENING ALLERGY (ANAPHYLAXIS) TO :
Peanut Insect stings other: Tree nuts Latex Egg Medication: Milk
Food: The key to preventing an anaphylaxis emergency is absolute avoidance of the allergen People with food allergies should not share food or eat unmarked / bulk foods or products with a “ may contain” warning
Epinephrine Auto-Injector: Expiry Date:
Dosage:
Epi-Pen JR 0.15 mg
Twinject 0 15 mg
Allerject 0.15 mg
Epi-Pen 0.30 mg
Twinject 0 30 mg
Allerject 0.30 mg
Location of Auto-Injector(s):
Previous anaphylactic reaction: Person is at greater risk
Asthmatic: Person is at greater risk If person is having a reaction and has difficulty breathing, give epinephrine auto-injector before asthma medication
1 Respiratory system (breathing): coughing, wheezing, shortness of breathe, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing
2 Gastrointestinal system (stomach): nausea, pain/cramps, vomiting, diarrhea
3 Cardiovascular system (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock Other: anxiety, feeling of “impending doom”, headache, uterine cramps, metallic taste
Early recognition of symptoms and immediate treatment could save a person’s life.
ACT QUICKLY. THE FIRST SIGNS OF A REACTION CAN BE MILD, BUT SYMPTOMS CAN GET WORSE VERY QUICKLY.
1 Give epinephrine auto-injector (e g , Epi-Pen Twinject or Allerject) at the first sign of a known or suspected anaphylactic reaction
2. Call 9-1-1 or local emergency medical services. Tell them someone is having a life-threatening allergic reaction
3 Give a second dose or epinephrine in 5 to 15 minutes IF the reaction continues or worsens
4. Go to the nearest hospital immediately (ideally by ambulance), even if symptoms are mild or have stopped The reaction could worsen or come back, even after proper treatment Stay in the hospital for an appropriate period of observation as decided by the emergency department physician (generally about 4 hours)
5 Call emergency contact person (e g parent, guardian)
Patient/Parent/Guardian Signature:
Physician Signature on File:
The undersigned patient, parent, or guardian authorizes any adult to administer epinephrine to the ooave-named person in the event of an anaphylactic reaction, as described above This protocol has been recommended by the patient’s physician
Date:
Date:

An Asthma Action Plan is a series of steps that you can use to manage your asthma when it gets out of control
Research has shown that having written agreement with your doctor is very helpful when managing asthma at home The aim of an Asthma Action Plan is to recognize the early warning signs of asthma and to take the appropriate steps
It helps you:
Take control of your asthma
Know when to increase or decrease your medications so that your asthma is well-controlled,
Decide when you should seek emergency help.
Take this Asthma Action Plan and discuss it with your doctor
You caught a cold, and today you are feeling wheezy and you find it difficult to do your usual activities Last night you woke up because you were having difficulty breathing and you found it hard to get back to sleep You need to take your reliever (blue) inhaler more and more Do you know what to do?
Respiratory infection, a common asthma trigger, often require a change to asthma treatment You may find yourself making medication changes on your own and wondering if you’ve made the right decision. Talk to your doctor now about the specific steps you should take when you are having asthma symptoms.
What works for one person with asthma may not work for you. It is very important to first gain a full understanding of all your choices and then to obtain guidance from your doctor on the appropriate steps to take.
For more information contact The Asthma Society of Canada at www asthma ca or call 1-866-787-4050
Name: Doctor’s Name:
Date:
Hospital/Emergency Room Phone Number:
This Action Plan is a guide only Always see a doctor if you are unsure what to do
Green Zone - I have symptom-free asthma
I have no symptoms:
•
•
• • I have no cough, wheeze, chest tightness or shortness of breath
I do not cough or wheeze when I exercise or sleep I can do all my usual activities I do not need to take days off work
• •
•
Yellow Zone - I have asthma symptoms
I cough, wheeze, have chest tightness or shortness of breath during the day when I exercise or sleep
I feel like I am getting a cold or the flu
I need to use my reliever inhaler more than three times a week for my asthma symptom
I need to either increase my controller medication or add on a difference controller
FIRST
SECOND
Take (Reliever) 2 puffs, every hours, as needed
Increase (Controller) until you are back in the green zone
If no improvements in to day, for days, or hours, call or visit your Doctor
Red Zone - I am in danger and need help
Any of the following:
•
•
•
•
•
•
• I have been in the Yellow Zone for 24 hours
My asthma symptoms are getting worse
My reliever does not seem to be helping
I can not do any type of activity
I am having trouble walking or talking
I feel faint or dizzy
I have blue lips or fingernails
I am frightened
This attack came on suddenly
Go directly to the nearest Emergency Room of your local hospital
FIRST This is an emergency Dial 911
SECOND
While waiting for the ambulance, take 2 puffs of ______ (Reliever inhaler) every 10 minutes
This form may help parents communicate important information to school staff about your child’s asthma Consider taking this form to your family physician, pharmacist or asthma educator to complete Give your child’s teacher a copy
Name:
Birth Date:
Name:
Name:
Phone (H): Phone (H):
Class/Grade:
Name: animal dander dust mites temperature change pollen fumes/odors other:
Phone: persistent or troublesome cough asthma symptoms during or following exercise complaints of chest tightness or shortness of breath having to use reliever inhaler more than twice a week
other: (W): (W): tired in class wheezing mould chalk dust respiratory infections
Please notify the parent when you observe the following early warning signs and symptoms: (check all apply)
Call 911 if: reliever medication not helping struggling to breathe pale or sweaty skin
I have observed _______________________________ ’s inhaler technique and it is my professional opinion that he/she is able to take their inhaler properly Inhaler technique will need to be reviewed on a yearly basis
Signature
Physician, Pharmacist or Asthma Educator
Date: difficult talking lips or fingernails are blue
