EpiPen® Auto-Injector $0Co-Pay Savings Offer

Auvi-Q $0 out of pocket offer

If your child has food allergies, please complete the following forms:

RPS Anaphylaxis Emergency Care Plan

This form gives the school authorization to administer epinephrine (e.g. EpiPen, Auvi-Q) to a child during an anaphylactic reaction (life-threatening allergic reaction) during the school day. This form is required annually.

Dietary Guidelines: Food Allergies & Intolerances 
This form provides guidelines for managing a student’s food allergy/intolerance to appropriate staff members (e.g. nursing, dietary,classroom teacher(s), special areas). This form is required annually.

Special Diet Statement Form
This form needs to be completed by your child's physician.  It gives Rochester Public Schools Student Nutrition Services direction on appropriate meal substitutions for a child's special diet (e.g. food allergies that result in severe, life-threatening (anaphylactic) reactions).

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