Medication at school

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Please complete any time your son will be bringing in medication to school.
One form to be completed for each new medication.

Student name *

Student Form *

Student Date of Birth *

YYYY

Name of medication *

Strength of medication *

Where will medication be kept? *

Main office

(FOR EMERGENCY MEDICATION ONLY, E.G. INHALER, EPIPEN ETC.)With student (placed securely in bag at all times when not being taken)

Locked in medical room cupboard (if controlled medication)

In fridge

Amount of medication (only supply enough for one day at a time if carried by the student) *

Dose to be taken *

Time to be taken *

Time

Expiry date *

YYYY

Contact details of parent (please supply name and daytime contact telephone number) *

Any other instructions

Submit

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