Parent / Carer consent to administer an "over-the-counter" (OTC) medicine.
If your child might require non-prescribed medicine to be administered during the residential visit please complete this form.

All over the counter (OTC) medicines must be in the original container.

A separate form is required for each medicine.

By completing this form you are:

Giving permission for the Head Teacher / Senior staff member (or his/her nominee) to administer the OTC medicine to your son/daughter during the time he/she is in our care. 

You confirm that the dose and frequency requested is in line with the manufacturers instructions on the medicine.

You are confirming that the information submitted is, to the best of your knowledge, accurate at the time of writing.
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عنوان بريد إلكتروني *
Child Name *
Class *
Childs date of birth *
Name of medicine *
Strength of medicine *
How much dose to be given                                                                                                                                                                                                                    For example: One tablet, 5ml spoonful *
At what time(s) the medication should be given *
الوقت
:
Reason for medication *
Duration of medicine                                                                                                                                                                                Please specify how long your child needs to take the medication for *
Are there any possible side affects that the school needs to know about? If yes please list them. *
Contact details in case of an emergency *
Name of GP Practice and contact number *
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