HPP Medication Consent Form

 Prescribed medication must be provided in its original packaging which clearly outlines the instructions for administration, dosage, storage and name of the child. Where possible parents should only send in to school the number of doses required during the school day, for the duration of the medication, so it may remain on the premises. Children will not be allowed to take medication home without an accompanying adult. A responsible adult must collect the medication from the office at the end of each day.

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Child's School *
Child's Full Name *
Child's Class *
Parent/Carer Name *
Emergency Contact 1- Name and Telephone Number *
Emergency Contact 2 - Name and Telephone Number *
Nature of illness or condition *
Name of Medication *
Dose and instruction for administration *
Frequency and times medication is required *
Completion date of course of medication (if known)
Expiry date of medication *
MM
/
DD
/
YYYY
I agree of members of staff administering medicines and providing treatment or care to my child as detailed above. *
I agree to update information about my child's medical needs, held by the school on a regular basis. *
I will ensure that the medicine held by the school has not exceeded it's expiry date. *
Procedures to be taken in an emergency *
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