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.
Reference: Section 10.52 Form 10.52.F.1