Medicine in school form

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Please complete this form if your child is required to take medication during school hours. Please ensure that an adult brings this to the school office. Please DO NOT send any medication in with your child.

Email *

Name of child *

Class *

Wrens

Robins

Skylarks

Barn Owls

Date medication provided to school. *

YYYY

Name and strength of medicine. *

Dosage - How much to be given? *

What is the medication for? *

When to be given? *

Any other instructions? *

I confirm that the details above are correct and I give my consent for the school to administer this medication. *

Yes

Name of consenting parent? *

SCHOOL USE ONLY - signed and dated by headteacher or teacher in charge.

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