Medical Consent Form for short term medicines in school Sept 2022 -July 2023. For pupils requiring either prescriptive (e.g antibiotics) or non prescriptive medication to support short term medical needs

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At The Hythe School we need to use and store some information about you and your child. The information required by this form is the name of your child and their date of birth, your name, your address, phone numbers, details of your child’s medical illness, details of your GP and information about any medication your child takes. This helps us to be aware of your child’s medical needs and support them in keeping safe in school.

All medication must be handed into the school office by an adult. Prescription medication :The medicine must be in it's original packaging, and the pharmacist label should show your child's name and the instructions and the expiry date. This information must not be obscured. For over the counter medication such as paracetamol, the bottle must be in the original packaging (not loose or in a bag), please label with your child's name.

Email *

Name of child and class *

DOB *

YYYY

Home address *

Parent/carer name *

Home telephone number

Mobile number *

Work number

Condition or illness *

GP name and address *

GP telephone number *

Please tick as appropriate *

My child will be responsible for the self-administration of medicines as directed below with supervision

I agree to a member of staff administering the medication as directed below

Required

Name of medication *

Dose *

Frequency/time *

Date medication will be completed *

YYYY

Special instructions

Allergies

I agree to update The Hythe Primary School about my child’s medical needs and that this information will be verified by the child’s GP and/or medical Consultant. *

Yes

I will ensure that the medicine held by The Hythe Primary School has not exceeded its expiry date. *

Yes

Todays date *

YYYY

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