Request For The Administration Of Medication In School

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Child Name *

Name of Parent/Guardian *

I request that the medication named below should be administered to my child whilst she/he is at school. I agree to the medication being administered by a member of the teaching or non-teaching staff and understand that such staff may have had no medical training

Name of Medication *

Dosage *

Reason for Medication *

When Medication Is To Be Administered *

I will ensure that all medication is brought to & collected from the school office. I understand that the responsibility for the administration of treatment rests with me.

Date *

Please provide a signature. *

Parrett & Axe CE VA Primary School

Parrett & Axe CE VA Primary School

Request For The Administration Of Medication In School