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Life-Threatening Allergies/Asthma:

All students must have a physician’s care plan and medication order indicated on the yearly physical or on an action plan. If parents and physicians allow the student to self-carry the medication, the following permission form must be completed. All students participating in interscholastic athletics must self-carry their own medication.

Permission to Carry and Self-Administer Epinephrine/Inhaler
Sample Asthma Action Plan
Allergy Action Plan

Daily Medication at School:

Completion of this form is required for all students needing medication administration at school. Please see the form for more detailed information.

Medication at School

Medication on Field Trips

Completion of this form is required for all students needing medication during field trips. Please complete as instructed prior to the departure of each individual trip. 

Field Trip Medication




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An Independent Day School
for Boys Grades 4-9

516 Monument Street, Concord, MA 01742

Tel: (978) 369-5800 Email:

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