Parental agreement to administer medicine

All medicines must be prescribed by a GP and clearly labelled and given to the school office.

If the dosage requirement is 3 times daily then the medication will not be accepted at school as the middle dose can be given by parents/carers after school.

Name of child* Name/type of medicine* Dosage and method (including time)* Any other instructions Are there any side effects that the school need to know about?* Parent/Carers name* Daytime telephone number* Relationship to child*

CONSENT

The above information is to the best of my knowledge accurate at the time of writing and I give my consent to school staff administering the medication in accordance with the school and the Education Department’s policy.

The school will be notified immediately, of any changes to the above.

Today's date* Print name*

If more than one medicine is to be given a separate form should be completed for each.