Medication permission form

Use this form if your child will need medication administered during the school day.

Please complete a separate form for each medication your child may need at school. The form includes information regarding the medication, dosage, administration instructions, possible side effects, and required parent/guardian and healthcare provider authorization.

Please return the completed and signed form to the school office along with the medication. Medication must be provided in its original container with the appropriate pharmacy or manufacturer’s label.