Medical Consent Form for long term/ongoing medicines in school Sept 2023 -July 2024. For pupils requiring prescription medication to support ongoing medical conditions.

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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. 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.

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 *

Expiry date of medication *

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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