Medication Consent Form

pdf version
St Margaret Ward Catholic Academy
 
Parent/Guardian Consent Form for the Administration of Medication
To be completed and returned when a child brings their own medication into school.
Please state below the child’s name and year, the name of the medication and course duration. On the table, please log the date, dosage and the time/s you wish your child to take their medication during the school day
 
Pupil’s name: ________________________________ Form: __________________
 
Name of medication: __________________________________________________
 
Duration of course: __________________________________________________________
 
 
  Date Dosage Time to be administered
Monday      
Tuesday      
Wednesday      
Thursday      
Friday      
 
 
I understand that I have to bring my child's medication into school and will notify you of any changes to the instructions given. It will be in a clearly marked original container/bottle with his/her name, along with the name of the medication, strength, dosage and also the name and telephone number of the dispensing chemist. The medication must be handed directly to reception. This will be passed to the Pastoral Support Office, where your child will go at the required time.
 
Pupils will be supervised administering their own medication.
 
All medication will be stored in a locked cabinet or refrigerated if required.
 
 
 
 
Signature of Parent/Guardian ____________________________ Date _____