<p> ALLERGY ACTION PLAN (AAP) (FOOD & BEE STING ALLERGIES ONLY)</p><p>______is allergic to______Student’s Name PHOTO</p><p>VIA: INGESTION, CONTACT OR INHALANT-PLEASE CIRCLE ALL THAT APPLY</p><p>Symptoms or signs your child might exhibit. </p><p>Symptoms can change quickly!</p><p>The following action must be taken immediately!</p><p>Call 911 – Request a paramedic with EPIEPHRINE. State the child had a severe allergic reaction, and additional epinephrine may be needed. </p><p>3. Parent/Guardian names and emergency contact numbers </p><p>1. Name______Phone______</p><p>2. Name______Phone______</p><p>3. Name______Phone______</p><p>4. Name______Phone______</p><p>IF PARENTS CANNOT BE REACHED WE AUTHORIZE A TRAINED STAFF MEMBER TO ADMINISTER MEDICATION INITIAL BOX IF YES</p><p>Physician’s Signature Date Grove Preschool Teacher Signature Dats</p><p>Grove Preschool Director Signature Date Parent/Guardian Signature Date </p>