Anaphylaxis Allergies and Epi-Pen Consent Form

Contact information

Allergy Details

 The key to preventing an Anaphylactic Emergency is absolute avoidance of the allergen.

Anaphylactic Allergies and the Administration of Epi-Pens Procedure.

Participants or their parents/guardians must notify the Community Services Department upon registering for programs if they require the use of an Epi-Pen.

Participants who require Epi-Pens are responsible to ensure that they have their Epi-Pens with them while attending the program. Epi-Pens must be carried by the participants, in a waist pack that is easily identifiable. The Municipality of Clarington does not supply Epi-Pens.

Recreation Program Staff will supervise only, the self-administration of Epi-Pens by participants.

In the event that a participant is not capable of administering the Epi-PEn themselves, Recreation Program Staff will administer the Epi-Pen using the hand over hand technique.

Participants must provide consent allowing staff to assist in administering an Epi-Pen, signed by a parent or legal guardian.

Recreation Program Staff will be required to have Epi-Pen training.