Parental Agreement for Administering Medicine
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Child's Name: *
Date of Birth: *
Year group: *
Description of illness: *
Name of Medicine: *
In the case of Calpol etc, is this as required or essential?
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Expiry Date: *
MM
/
DD
/
YYYY
Dosage and Method: *
Time that medicine must be given: *
Dates that medicine must start and stop: *
Additional Instructions:
Procedures to take in an emergency:
Name of parent/carer: *
Contact number: *
Relationship to child: *
I understand that I must deliver this medicine personally to a member of NSPS staff: *
The above information is, to the best of my knowledge, accurate at the time of writing and I give consent to school/setting staff administering medicine in accordance with the school.  I will inform the school immediately in writing if there is a change in dosage or frequency of the medicine or if the medicine is stopped. *
Date of completion: *
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