OLD - Medicine Administering Form

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The school will not give your child medicine unless you complete and sign this form, and the school has a policy that the staff can administer medicine.

*PLEASE NOTE ALL MEDICINES MUST BE PRESCRIBED BY A DOCTOR BEFORE THE SCHOOL CAN ADMINISTER.

Email *

Name of Child *

Year /Class *

Medical condition of illness *

Name/type of medicine(as described on the container) *

Dosage *

Timing *

Special precautions/other instructions *

Are there any side effects that the school needs to know about? *

GP Details *

Or where the medication was prescribed

Contact Name & Relationship to child *

I understand that I must deliver the medicine personally and the above information is, to the best of my knowledge, accurate at the time of writing and I give consent to school staff administering medicine in accordance with the school policy. I will inform the school immediately, in writing, if there is any change in dosage or frequency of the medication or if the medicine is stopped.

A copy of your responses will be emailed to the address you provided.

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