Inhaler Form
 
Northland Community Schools
Independent School District #118
316 Main Street East, Room 200
Remer, Minnesota 56672
(218) 566-2351 FAX (218) 566-3199
Dear Parent,
Recent legislation by the State of Minnesota allows students who use inhalers to self
administer and carry the inhalers at school and on the bus.
However, for this to occur, we need:
1. Written authorization from the parent permitting the student to self-administer.
2. The inhaler must be clearly and properly labeled for that student.
3. Parent must verify that the child has the knowledge and skill to safely use the
inhaler.
If you wish to have your child carry and self administer his/her inhaler, please sign, date and
return the form on the bottom of this note to the building your child attends.
The permission must be renewed annually.
I, ________________________________________(print name) authorize my
child(ren) ________________________, ________________________,
________________________, ________________________,
To carry and self-administer his/her inhaler.
I verify that my child(ren) has the knowledge and skill to safely use the inhaler.
_____________________________________ ____________