Medication Drop Off
Please select a time slot for medication drop off.

You will be able to drop medication off during your scheduled Open House time.
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Name of Parent/Guardian Dropping Medication Off *
Phone Number of Parent/Guardian Dropping Medication Off *
Name of Student *
Grade of Student *
Please select a time slot from the options below: *
Parent/Guardian Responsibilities
The parent/guardian must provide the school with:
• Pharmacy label must be exact to include medication dosage, time, and interval. No ranges.
• A complete CCS Confidential School Health Form.
• Written parent/guardian consent (schools operate in loco parentis; therefore 18-yearold students who are living with their parent/guardian should still have parent/
guardian consent).
• Medications, orders, consents, and supplies.
• A written provider order on an approved CCS medication form(s) and supplies to
meet requirements of the order.
• Sign release of liability.
• Sign authorization for school to communicate with student’s health care provider, if
• Provide the medication(s) and any needed supplies or equipment for administration
(e.g., syringes and needles, spacers, etc.).
• Check-in and sign out medicines with medication clerk.
• Count/measure medications with the medication clerk before acceptance.
• Bring all medications in an original pharmacy labeled container that matches the
physician’s order.
• It is the responsibility of the student’s parent/guardian to replace used and expired
• The parent/guardian must deliver backup medicine before a student is allowed to
self-carry with emergency medication.
• The parent/guardian will have 30 calendar days to provide the school with
appropriate documentation and medication to meet the medical need.
• The parent/guardian must present emergency medications within 30 calendar days
to school medication clerk. A physician’s order must accompany all requests from
the parent/guardian to administer medication.
• The parent/guardian of students who self-medicate during the school day are held
liable if another student takes the medication. The school system will assume no
liability for students who self-medicate.
• Backup emergency medication is required by House Bill 496 parent/guardian must
provide backup medicine for all students who self-administer.
• Communicate any changes in a student’s health status and or medication regime.
• A parent/guardian may sign out their student’s medication from the school at any
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