Form from: Ribby With Wrea Endowed CofE Primary

Parental agreement for school to administer medication.

We will not give your child medicine unless you complete and sign this form. 

NB:  All medication must be in the original container as dispensed by the pharmacy.

Name of child

Medical condition or illness

Name or type of medicine (as described on the container)

Expiry date

Please state the dosage and method

Please state the times it is to be administered in school and for how long.

Please state any special precautions or other instructions

Are there any side effects school need to be made aware of?

Self Administer

Please sign below

signatureplease use your mouse or finger sign above

Your name

Your email