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Over the counter medication consent form
(This form needs to filled out for every student, every year)
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* Indicates required question
Email
*
Your email
Students last name:
*
Your answer
Students first name:
*
Your answer
May your student have tylenol?(Per dosage instructions for fever, headache, cold, sore throat, menstrual cramps, and earache)
*
yes
no
May your student have Benedryl? (Per dosage instructions for itching, sneezing, hives, etc.)
*
Yes
No
May your student have ibuprofen? (Per dosage instructions for cramps, muscle strain, backache, and headache)
*
Yes
No
May your student have cough drops?
*
Yes
No
May your student have Pepto bismol? (Per dosage instructions for upset stomach and heartburn)
*
Yes
No
May your student have Rolaids, Tums, Mylanta (Per dosage instructions for upset stomach and heartburn and if over age 11)
*
Yes
No
Parent Signature/Date
*
Your answer
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