• Section 10.52.F.1 - Parental Consent for Medication Administration at School


  • (Only one medication per form)

    I hereby request and give my permission for the school nurse/health assistant or person designated by the administrator to see that my child,

  • receives the following medication for the period

  • In addition, I give my permission for the above designated people to share this information with other authorized personnel.

    I will provide mediation and associated supplies in the original, pharmacy labeled currently dated container and medication will only be administered according to the container's directions.

  • I understand and agree that in the event of a medication related emergency, one of the following individuals will be contacted. If the individuals are unavailable, 911 (Emergency Medical Services) will be called.

  • Add
    1. To assure the safety of all students, parents are responsible for transporting their child's medication to and from the school health office.
    2. Children may not have any type of medication or cough drops in their possession while attending school or school activities.
    3. Verbal permission will not be accepted. Hand written notes are accepted for one day only and signed consent must be submitted within 24 hours for continued medication administration.
    4. Immediately notify the school nurse / health assistant or designated person in writing of all changes in medication. A new consent must be submitted within 24 hours.
    5. Your child's Health History Form must be kept current throughout the school year.
    6. Parents are responsible for providing an adequate supply of medication for administration during school hours.
    7. All requirements must be met for medication to be administered during school hours.
    8. Parents must pick-up their child's medication on his/her last day of attendance. Medication remaining after the child's last day of school will be properly disposed of.
  • Reference: Section 10.52 Form 10.52.F.1

    Revised 2/06/18