Consent to administer medication

Form from: Low Moor C.E. Primary School

This form has been archived

Dear parent/carer,

Consent to administer medicine

The school only administers medicines that have been prescribed by a healthcare professional or doctor that need to be taken four times a day.

The school will not give your child medication unless you complete and sign this form as permission to administer.

Medicines must be labelled with the child's name, be in the original container and should be handed into a member of staff at the school office.

Medicine cannot be administered to your child until this completed form has been received.

Paper copies of all our documents are available via the school office, however we strongly encourage that this form is completed online.

Thank you for your support.

Child's Details

Name of child

Class

Date of Birth

Medical condition or illness

Medication

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

Expiry date

Dosage and method

Time medicine to be given

Special precautions/other instructions

Are there any side effects that the school need to know about?

Can the child self administer?

Procedure to be taken in the event of an emergency

Details of parent/carer completing this form

Name

Daytime telephone number

Relationship to child

Address

Declaration

I understand that I must deliver the medication personally to (agreed member of staff) and I consent to authorised staff administering the above medication to my child. I accept that this is a service which the school is not obliged to undertake.

I consent to medical information concerning my child’s health to be shared with other school staff and/or health professionals to the extent necessary to safeguard his/her health and welfare.

I confirm that the medication has been prescribed by a doctor/consultant and that this information has been provided in consultation with my child’s doctor/consultant.

Please sign below

signature _{please use your mouse or finger sign above}