LWA Prescription Medication Request
I hereby request that my child be allowed to take the following medication at LWA. I will bring the prescription medication to the LWA office in the appropriately labeled container.
Child's Name *
Your answer
Child's Grade *
Your answer
Name of Medication *
Your answer
Dosage *
Your answer
Time to be given *
Time
:
How long medication will be needed *
Your answer
Parent's Name *
Your answer
Medication must be sent in by parent/guardian with the prescription label on bottle. This is the order from the doctor giving permission for the child to have the medication.
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