Request for Medicine to be Administered in School
Please fill out the form below to make the school aware of any medicines you would like administered during the school day.
Parents Name *
Your answer
Pupils Name *
Your answer
Class *
Name of medicine *
Your answer
Dose *
Your answer
When *
Required
Other Time (if applicable)
Your answer
End Date *
MM
/
DD
/
YYYY
Reason for medicine *
Your answer
Submit
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