Parental agreement for Elham School to administer medication

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Parental agreement for Elham School to administer medication

If your child requires medicine to be given to them during the school day, please complete and sign the form below giving permission for a member of Elham School staff to administer the medication.

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* Indicates required question

Email *

Your email

Child's name *

Your answer

Date of birth *

MM

/

DD

/

YYYY

Class name *

Your answer

Medication (Full name) *

Your answer

Dosage (puffs if inhaler or spoonfuls) *

Your answer

Time/s to be given *

Time

:

AM

PM

Number of days to be given *

Your answer

Any other instructions *

Your answer

Parent's daytime telephone number *

Your answer

Name & telephone of GP *

Your answer

Any other information *

Your answer

Submit

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