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Consent form for the storage and administration of medicines in school
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* Indicates required question
Email
*
Your email
Name of Pupil
*
Your answer
Pupil's date of birth
*
Your answer
Which Invicta site does your child attend?
*
Blackheath
Deptford
Pupil's Year and Class
*
Your answer
I confirm that I have parental responsibility for the above child because I am their:
*
Mother
Father
Person with Residence Order
Guardian with parental responsibility
Other:
Name of medicine
*
Your answer
Required dosage
*
Your answer
Time to be administered
*
Your answer
How is the medicine to be administered
*
Orally
Cream/Ointment to skin (applied by the child/ supervised by the first aider)
Ear/Eye/ Nose Drops
Additional information to be given about the medicine:
Your answer
Name of the person to be contacted during the day:
Your answer
Telephone/ Mobile Number:
Your answer
I hereby give consent for the above medicine to be given to the pupil and confirm that it may be administered by a member of staff/ first aider as indicated above.
Yes
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