Medication Policy Form - (Form MP1)

Medication Policy Form - (Form MP1)

* If applicable

Staff will administer medication to your child only if the following conditions are adhered to;

a) the parent must give the medication to the homeroom teacher and it must be accompanied by this signed permission form.

b) the medication must be prescribed by a doctor

c) the staff cannot administer over-the-counter medication under any circumstances.
Child/ren's Name*
First Last
Parent's Name*
* If applicable Staff will administer medication to your child only if the following conditions are adhered to; a) the parent must give the medication to the homeroom teacher and it must be accompanied by this signed permission form. b) the medication must be prescribed by a doctor c) the staff cannot administer over-the-counter medication under any circumstances.

Save and Continue Later

Save and Continue Later

Please check the box beside the statement.
- I give my permission for my child/ren’s teacher to administer the medication prescribed by the doctor mentioned below to my child.
Parent Signature
Date
Date Format: MM slash DD slash YYYY

Save and Continue Later

Hitherfield School