Request for the Administration of medication in school
(To be agreed with the school before medicine will be given.)
I request that my child …………………………………….(Name) be given the following medicine by school staff during the school day. The medicine cannot be given before and after school only because*:
………………………………………………………………………………………….
Name of medication? …………………………………………….. (as on container)
Method of administration? ……………………………………….
Dose of medication? ………………………………………………
Time of administration? ………………………………………….
Duration of treatment? ……………………………………………
Possible side effects? …………………………………………….
Can the medication be self administered by the pupil? YES/NO
Signature ……………………………………..
Date …………………………………………….
*The school regards 3-a-day antibiotics as Breakfast, Tea and Bedtime doses unless it can be shown that a lunchtime dose is necessary.
AGREED
The school will endeavour to administer the medicines noted above at the times agreed.
Signed …………………………………………
Name …………………………………………..
Date …………………………………………….
Whilst every effort will be made to adhere to the doses and times etc. noted above, the school will not be held responsible should any error occur and that in any case, where doubts or queries arise, no medicine will be administered before satisfactory confirmation is received from parent(s) or guardian. No medicine past its expiry date will be given.
Please print and complete for any new medication and return to school or email to
stjosephsjunior@npt.school