Template B: parental agreement for setting to administer medicine The school/setting will not give your child medicine unless you complete and sign this form, and the school or setting has a policy that the staff can administer medicine. Date for review to be initiated by Name of school/setting Name of child Date of Medical condition or illness Medicine Name/type of medicine (as described on the container) Expiry date Dosage and method Timing Special precautions/other instructions Are there any side effects that the school/setting needs to know about? Self-administration y/n – Procedures to take in an emergency NB: Medicines must be in the original container as dispensed by the pharmacy Contact Details Name Daytime telephone no. Relationship to child Address I understand that I must deliver the [agreed member of staff] medicine personally to
Template B: parental agreement for setting to administer medicine The school/setting will not give your child medicine unless you complete and sign this form, and the school or setting has a policy that the staff can administer medicine. Date for review to be initiated by Name of school/setting Name of child Date of Medical condition or illness Medicine Name/type of medicine (as described on the container) Expiry date Dosage and method Timing Special precautions/other instructions Are there any side effects that the school/setting needs to know about? Self-administration – y/n Procedures to take in an emergency NB: Medicines must be in the original container as dispensed by the pharmacy Contact Details Name Daytime telephone no. Relationship to child Address I understand that I must deliver the medicine personally to [agreed member of staff]