MEDICAL FORM

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MEDICAL FORM

COMPLETE THIS FORM IF YOUR CHILD HAS TO BRING MEDICINE TO SCHOOL.

WE CANNOT ADMINISTER THE MEDICINE WITHOUT A COMPLETED FORM

Child's Name *

Date form completed *

YYYY

Medicine Name *

Has the medicine been prescribed by a doctor? *

Yes - it is named.

Expiry date on medication (We can not administer medicine that is out of date) *

YYYY

Special instructions - INCLUDING STORAGE

Time of dosage *

Dosage amount *

Best person to contact if needed:

Best contact number

Home

Mobile

Work

Other:

Clear selection

I WILL EMAIL SCHOOL TO LET THEM KNOW I HAVE COMPLETED THE FORM *

Submit

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