2025-2026 Back to School Guide
Message from Head of School
Dear Members of the Rowntree Community,
As the 2024–2025 school year draws to a close, I would like to take this opportunity to extend my deepest gratitude to each and every member of our Rowntree community. This year has been a journey of growth, achievement, and connection made possible by the collective efforts of our dedicated staff, remarkable students, and you our supportive and engaged parents.
I am incredibly proud of our students. Their determination, curiosity, and resilience have shone brightly across all areas of school life Whether in the classroom, on the stage, during athletic competitions, or through acts of kindness and leadership, their accomplishments both big and small reflect the values we hold dear at Rowntree
The 2024–2025 school year was filled with memorable milestones that brought us together as a community. From the joyful return of our beloved Mini Olympics to the touching Prep One and Grade Eight Graduation ceremonies, each event was a reminder of the strength and spirit that define our school. These shared moments have helped nurture a deep sense of belonging and pride among our students, families, and staff
I would also like to offer a heartfelt thank you to our parents and guardians Your unwavering support, encouragement, and active partnership are essential to all that we do. The launch of our Friends of Rowntree Parent Association this year marked a meaningful step forward in strengthening our home–school connection, and your involvement has already made a significant difference in enriching student life.
As we head into the summer months, I encourage you to take time to rest, recharge, and enjoy special moments with your loved ones. We are already looking ahead with excitement to the new school year and all the possibilities it holds Please stay tuned for our Parent/Student Handbook, which will be shared later this summer with important information and updates for the 2025–2026 school year
Wishing you a safe, joyful, and well-deserved summer break We look forward to welcoming you back in the fall!
Warm regards,
Mrs. Darlene Schewske
Head of School
School Calendar
First Day of School
2025-2026
Professional Development Day (no class)
Thanksgiving Holiday (no class)
Professional Development Day (no class)
Last day of classes before Winter Break
Professional Development Day (no class)
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)
Victoria Day Holiday (no class)
Professional Development Day (no class)
Last Day of School
SEP 2, 2025 (Tue)
OCT 10, 2025 (Fri)
OCT 13, 2025 (Mon)
NOV 14, 2025 (Fri)
DEC 18, 2025 (Thu)
DEC 19, 2025 (Fri)
DEC 22, 2025 - JAN 2, 2026 (Mon-Fri)
JAN 5, 2026 (Mon)
FEB 13, 2026 (Fri)
FEB 16, 2026 (Mon)
MAR 27, 2026 (Fri)
MAR 16 -20, 2026 (Mon-Fri)
APR 3, 2026 (Fri)
APR 6, 2026 (Mon)
MAY 15, 2026 (Fri)
MAY 18, 2026 (Mon)
JUN 1, 2026 (Fri)
JUN 17, 2026 (Wed)
Important Reminders
FIRST DAY OF SCHOOL
School begins on Tuesday, September 2, 2025, at 8:40 a m sharp
UNIFORM
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 shopping code: rtms or in person at their store at 5359 Timberlea Blvd, Unit 54, Mississauga, ON L4W 2R7 All Grade 7 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
SCHOOL SUPPLIES LIST
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
TEXTBOOKS
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
PRE-AUTHORIZED DEBIT
Parents who have signed up for Pre-Authorized Debit to pay tuition fees: The first withdrawal from your bank account will be August 1, 2025
School Supplies & Textbooks
•
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
Kindergarten Montessori
STATIONERY SUPPLIES
1 1 large Ziploc bag containing a change of clothes pack of sharpened pencils - 12 pack
2 erasers (only white) 1 3 1 pencil sharpener with shaving catcher packs crayons - 24 pack pack pencil crayons - 24 pack
2 packs of washable markers 1 5 3 2 1 pair of scissors (child-safe) glue sticks bottles of liquid glue soft pencil cases to contain the above auxiliary not Bluetooth headset
3 sketchbooks for free-time drawing (mandatory for K-4 students)
3 exercise notebooks - 80 page
2 graph notebooks - 1 cm square - 80 page
1 block of construction paper
5 folders with pockets (no prongs) (French)
1 school-size backpack for everyday
•
STATIONERY SUPPLIES
HB #2 pack of sharpened pencils
pack of pencil crayons - 24 pack
pack of crayons - 24 pack
pack of washable markers - 12 pack
erasers
glue sticks
bottle of liquid glue
pair of scissors (child-safe)
soft pencil cases to contain the above
auxiliary not Bluetooth headset
pack of construction paper
sketchbook for free-time drawing (mandatory for K-4 students)
•
Grade 1
STATIONERY SUPPLIES
1 ruler - 30 cm
1 ruler - 12 cm
4 packs of sharpened pencils
2 packs of pencil crayons (12 or 24 packs)
2 packs crayons
2 packs of markers
5 erasers
2 sharpeners
4 glue sticks
1 1 bottle of liquid glue pair of scissors (child-safe)
2 pencil cases to contain the above
1 1 auxiliary not Bluetooth headset construction paper book
2 sketchbooks for free-time drawing (mandatory for K-4 students)
1 sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
2 80 page stapled exercise notebooks (not spiralled) 1
80 page graph notebook (1cm squares)
3 32 page exercise notebooks
6 three-prong duo tangs with pockets
1 32-page blue exercise notebook (French)
•
Grade 2
STATIONERY SUPPLIES
1 ruler - 30 cm
1 pack of pencil crayons
1 pack of markers
3 pack sharpened pencils - 12 pack
5 erasers
2 sharpeners with shaving catcher
5 1 1 glue sticks (preferably large) bottle of liquid glue pair of scissors (child-safe)
2 pencil cases to contain the above
1 1 auxiliary not Bluetooth headset construction paper book
2 sketchbooks for free-time drawing (mandatory for K-4 students)
1 Mindful colouring book
1 sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
10 80 page stapled exercise notebooks (not spiralled)
2 80 page graph notebook (1cm squares)
1 40 page exercise notebook
1 32-page exercise notebook (Music)
1 32-page blue exercise notebook (French)
10 three-prong duo tangs with pockets
Grade 3
STATIONERY SUPPLIES
1 4 15 cm ruler 30 cm ruler
protractor
pack sharpened pencils - 12 pack packs of pencil crayons - 12 pack
pack of markers - 12 pack erasers
2 sharpeners with shaving catcher 4 2 1 2
glue sticks
bottles of liquid glue
pair of scissors (child-safe)
pencil cases to contain the above Chromebook
mouse for Chromebook auxiliary not Bluetooth headset
pack of coloured paper
2 sketchbooks for free-time drawing (mandatory for K-4 students)
1 1 Mindful colouring book sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
11 stapled not spiralled exercise books - 80 pages
12 stapled, not spiral-bound exercise books - 40 pages
1 32-page exercise notebook (Music)
1 40-page blue exercise notebook (French)
3 graph notebooks (1cm squares)
4 three-prong duo tangs with pockets (preferably red, blue, yellow, and green)
4 three-prong duo tangs with pockets (preferably black)
Grade 4
STATIONERY SUPPLIES
1 15 cm ruler
1 30 cm ruler
1 1 1
1 protractor
pack sharpened pencils - 12 pack
pack of pencil crayons - 12 pack
pack of erasers - 3 pack
2 sharpeners with shaving catcher
4 glue sticks
1 pair of scissors
2 pencil cases to contain the above
1 three-dial combination lock (no luggage locks)
1 Chromebook (mouse optional)
1 1 set of headphones construction paper book
2 sketchbooks for free-time drawing (mandatory for K-4 students)
1 sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
4 stapled not spiralled exercise books - 80 pages (preferably pink)
2 stapled not spiralled exercise books - 80 pages (preferably green)
2 stapled not spiralled exercise books - 80 pages (preferably yellow)
2 stapled not spiralled exercise books - 80 pages (preferably blue)
1 stapled not spiralled exercise book - 40 pages
1 32-page exercise notebook (Music)
1 80-page blue exercise notebook (French)
4 graph notebooks - not spiral bound - 80 pages (1 cm grid)
4 three-prong duo tangs with pockets (Pink-1, Green-1, Yellow-1, Blue-1)
3 three-prong duo tang with pockets (plastic) - red
•
Grade 5
STATIONERY SUPPLIES
1 transparent standard ruler 30 cm
1 Oxford Geometry set
2 packs sharpened pencils - 12 pack
1 1 each of coloured erasable pens (black, blue, red) 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 shaving catcher
5 1 glue sticks pair of scissors
2 pencil cases (soft cloth)
1 three-dial combination lock (no luggage locks)
1 calculator
3 novels of choice (independent reading)
1 set of headphones
2 bright, colourful cardstock paper packs
1 ring-bound sketchbook (9” x 12”) - 50 pages
2 sketchbooks for free-time drawing (mandatory for K-4 students)
1 sketchbook for Art classes - 8.5”11” sketchbook, 100 Sheets
10 stapled not spiralled exercise books - 80 pages
2 stapled not spiralled exercise book - 40 pages
5 graph notebooks (1 cm square graph paper)
5 three-prong duo tangs with pockets (red, blue, green, yellow, black)
1 three-prong duo-tang with pockets (plastic)
2 16" by 24" canvas
4 Pack of adhesive rhinestone sheets
1 32-page exercise notebook (Music)
1 80-page blue exercise notebook (French)
•
STATIONERY SUPPLIES
• 1 ruler in cm
1 Geometry set
1 pack pencils - 12 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 1 1 1 1 1 scientific calculator set of headphones
pack of graph paper pack of lined paper
pack of blank paper
sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
10 stapled not spiralled exercise books - 80 pages
1 stapled not spiralled exercise book - 40 pages
4 graph notebooks
1 three-prong duo-tang with pockets
1 three-prong duo-tang with pockets (plastic)
1 32-page exercise notebook (Music)
1 80-page blue exercise notebook (French)
•
STATIONERY SUPPLIES
1 ruler in cm
1 Geometry set
1 pack pencils - 12 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
1 scientific calculator set of headphones
pack of graph paper pack of lined paper
pack of blank paper
sketchbook for Art classes - 8 5”11” sketchbook, 100 Sheets
9 stapled not spiralled exercise books - 80 pages
1 stapled not spiralled exercise book - 40 pages
4 graph notebooks
1 three-prong duo-tang with pockets
1 three-prong duo-tang with pockets (plastic)
1 one-inch ring binder
two-inch ring binder
32-page exercise notebook (Music)
80-page blue exercise notebook (French)
STATIONERY SUPPLIES
1 ruler
1 Geometry set
12 pencils
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 1 1 1 1 1 scientific calculator set of headphones
pack of construction paper
pack of lined paper (pack of 100)
pack of blank paper
sketchbook for Art classes - 8.5”11” sketchbook, 100 Sheets
13 stapled not spiralled exercise books - 80 pages
1 stapled not spiralled exercise book - 40 pages
4 graph notebooks
1 three-prong duo-tang with pockets
1 three-prong duo-tang with pockets (plastic)
2 one-inch ring binder
1 32-page exercise notebook (Music)
1 80-page blue exercise notebook (French)
Textbook Orders
ALPHA TEXTBOOKS
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
ORDERING 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).
RETURNS AND REFUNDS
Books may be returned for a full refund up to September 30, 2025. 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
Uniform Guide
Grade 1-6
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) 2045
Navy Ribbed Socks
Green Crested V-Neck Knit Vest
Navy Essex Shorts
Grade 7-8
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 Short
Adult Regular Tie
Navy Ribbed Socks
Code
7501 Green Crested Knit Cardigan Chest: 24” - 28”
Formal Shirts (various Style options) 4024 6050 6040 White Crested Short Sleeve Polo
Code Description Description
White Short Sleeve Katie Collar Blouse
White Long Sleeve Katie Collar Blouse
Navy Crested Side Pleated Tunic
Navy Knee High Socks
Navy Tights (Youth)
2 - 7/8
22” - 28”
2 - 8 Shoe Size
4/6 - 6/8
Navy Junior Pant
3/4 - 7/8
Grade 1-6
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” - 38”
Chest: 22” - 38”
2535 9510 8010 8520 8510 2083 2080
Navy ECO Skort
Navy Floppy Bow Tie
Navy Knee High Socks
Navy Tights (Youth)
Navy Tights (Adult)
2/3 - 11/12 One Size Shoe
Navy Junior Pant
Navy Adjustable Pant
3/4 - 13
4 - 16
26” - 42”
Code
7-8
Green Crested ECO Blazer
Blackwatch Tartan Kilt Chest: 28” - 42”
Age: 12 - 16
Formal Shirts (various Style options)
Adult Small - XL
6050 6040 White Short Sleeve Katie Collar Blouse Chest: 22” - 38”
White Long Sleeve Katie Collar Blouse Chest: 22” - 38”
Navy Adjustable Pant (Winter)
RTM Tartan Tie (various Style options) 9510
Navy Floppy Bow Tie
Adult Small - XL 1045 2500
Navy Knee High Socks
Navy Tights (Adult)
Age: 4 - 16
26” - 42”
Shoe Size
Bottoms (various Style options)
School Emergency Treatment Plan
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 August 31
PARENT/GUARDIAN INFORMATION & RESPONSIBILITIES
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
PARENT/GUARDIAN OBLIGATIONS
“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
ANAPHYLAXIS EMERGENCY TREATMENT PLAN
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.
EPINEPHRINE AUTO INJECTORS: EPI PENS
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.
RMS POLICY IS FOR PARENTS TO PROVIDE TWO EPI PENS
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
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 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
EXPIRY DATES OF EPI PENS
Parents are responsible to keep track of the expiry dates of their child’s Epi Pens and to provide a current Epi Pen when the old one becomes expired.
CHANGE OF INFORMATION MEDICATION
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.
MEDIC ALERT INDENTIFICATION
• 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
TEACH YOUR CHILD
• • • • about his/her allergy and substances that trigger a reaction strategies in avoiding harmful allergens in the child’s environment to recognize the symptoms of an anaphylactic reaction to communicate clearly to a responsible adult that he/she is anaphylactic student when he/she feels a reaction starting or a general feeling of unwellness.
•
•
•
• • • the importance of knowing where their Epi Pen is at all times. the importance of wearing/carrying their Medic Alert identification to only eat foods approved by parent/guardian. not to eat foods other then their own not to share snacks, lunches or drinks, food utensils, food containers and to place a barrier (e g placemat) between their food and the table where they are eating. the importance of hand washing how to advocate for themselves when by explaining their life threatening allergy to new friends, adults and/or significant others to report all incidents of teasing and bullying to an adult in authority communicate immediately to a friend, a responsible adult, teacher etc if they are aware of accidental exposure or an impending reaction strategies on how to deal with and resist peer pressure not to go off alone (e g washroom) unaccompanied if they are experiencing an allergic reaction or feeling unwell. If they lose consciousness they will not be able to ask for help
•
•
•
•
•
•
•
•
Child/Student Information & Responsibilities
• 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) who you can advise if a reaction is occurring and 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 age appropriate when and how to use it
Comply and assist, where possible, the administration of the auto-injector 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
• • NOT to eat foods other then 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
• NOT to go off alone (e g 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
• REQUEST AND CONSENT FOR THE ADMINISTRATION OF EPINEPHRINE
Anaphylaxis Form
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
A. TO BE COMPLETED BY THE PARENT GUARDIAN
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)
B. STATEMENT OF UNDERSTANDING
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:
C. TO BE COMPLETED BY THE PARENT/GUARDIAN
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:
D. REQUEST AND CONSENT FOR THE ADMINISTRATION OF EPINEPHRINE
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:
Anaphylaxis Emergency Plan
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
A PERSON HAVING AN ANAPHYLACTIC REACTION MIGHT HAVE ANY OF THESE SIGNS AND SYMPTONS
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)
EMERGENCY CONTACT INFORMATION
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:
Name Relationship Home Phone Mobile Work Phone
Photo
•
Asthma
WHAT IS AN ASTHMA ACTION PLAN?
An Asthma Action Plan is a series of steps that you can use to manage your asthma when it gets out of control
WHY USE AN ASTHMA ACTION PLAN?
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
HOW DO I GET A CUSTOMIZED ASTHMA ACTION PLAN
Take this Asthma Action Plan and discuss it with your doctor
WHAT SHOULD YOU DO IF?
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
Action Plan
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
Student Asthma Form
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:
PARENTS OR GUARDIAN
Name:
Name:
FAMILY PHYSICIAN
Phone (H): Phone (H):
Class/Grade:
PERSONAL ASTHMA TRIGGERS
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)
EMERGENCY TREATMENT
Wehn to Use
Call 911 if: reliever medication not helping struggling to breathe pale or sweaty skin
FOR ALL INHALED MEDICATION
I have observed _______________________________ ’s inhaler tech 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
