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Over the Counter Medication Administration 
2025/2026 School Year  
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Scituate Middle and High School 
In accordance with the standing orders of the school physician, acetaminophen, ibuprofen, and tums may be given to students with parental authorization. These medications will only be administered by the school nurse and will not be available on field trips or during after school clubs or sports. This form is only valid for one school year and must be resubmitted annually. 

This form is not mandatory to complete and may not be appropriate for all students. Please only complete this form if it is requested that your child receive over the counter medications during the school day without needing to be contacted first. Please complete only one form per student. 

The nurse no longer supplies liquid OTC medication. If your child requires liquid medication, a labeled bottle can be sent in to the school and kept locked in the nurse's office. 
I understand the school nurse will not contact me each time my child receives any OTC medication at school. *
Required
I understand that I must notify the school nurse verbally or in writing if I want to revoke my permission for medication administration.
 *
Required
Student First Name  *
Student Last Name  *
Student Grade  *
I give permission for my child to receive (check all that apply)  *
Required
Parent/Guardian Name  *
A copy of your responses will be emailed to .
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