Parental Authorization and Release Form:  Administration of Non-Prescription Drugs to Students 23/24
While the administration of medications to students should be scheduled outside of school hours whenever possible, occasionally it may be necessary for school personnel to administer nonprescription drugs to a student as authorized by the student's parents, guardians, or medical professionals and state law.  School personnel will only dispense those nonprescription drugs which have been approved by state and federal law for use as a drug and meet the definition of nonprescription drugs in Nebraska's Medication Aide law which states: 
Nonprescription drugs means non-narcotic medicines or drugs which may be sold without a medical order and which are prepackaged for use by the consumer and labeled in accordance with the requirements of the laws and regulations of this state and the federal government.
In order for student to be administered nonprescription medication by school personnel, a parent or guardian must:
  • Complete this authorization form
  • Provide the district with any nonprescription drugs you wish to be administered in its original container from the manufacturer, which must include legible, unadulterated manufacturer instructions.  The container must be labeled with the student's name.
  • Provide the district with specific written instructions regarding the requested nonprescription drug's administration, including the date(s) the student is to be administered the drug, the dosage to be administered, the frequency of administration, and any other details or conditions relevant to administration.
School personnel will not administer nonprescription drugs in a manner inconsistent with the manufacturer instruction or state law.  School personnel will not administer non-prescription drugs that are expired. 
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Email *
Name of Student *
I authorize and request school personnel to administer nonprescription drugs to my student.  I release the school district, its officials, and employees from any and all liability concerning the administration of nonprescription drubs to my student.

Parent/Guardian Signature:
*
Date *
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Time *
Time
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