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Permission to Administer Medicine in School - Dundonald Primary School
Staff will only give your child prescribed medicine when you complete and submit this form and the Headteacher has agreed that the staff can administer the medication.
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* Indicates required question
Pupil's Full Name
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Your answer
Class
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Your answer
Date of Birth
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Your answer
Name of medication (as written on container)
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Your answer
How long will your child take the medication for?
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Your answer
First date medication needs to be taken
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Your answer
Full instructions for use - dosage and method
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Your answer
Reason for medicaton
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Your answer
At what time should it be taken?
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Your answer
Special precautions (if any)
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Your answer
Side effects (if any)
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Your answer
Procedure in case of emergency
*
Your answer
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