To be completed by school: CONFIRMATION OF THE SCHOOL’S AGREEMENT TO ADMINISTER NON-PRESCRIBED MEDICATION I agree that (name of child): will receive (quantity and name of medicine): as detailed overleaf. This child will be given/supervised whilst he/she takes their medication by a member of staff. If a member of staff is not available to give/supervise the administration of this medication for any reason, the medication will not be given to the child and the parent will be informed. Name of Head Teacher/designated person: Signature: Date: CONFIRMATION OF STAFF’S AGREEMENT TO ADMINISTER NON-PRESCRIBED MEDICATION I have read this request for the school to issue non-prescribed medication in school and agree to administer as detailed above to this pupil. Staff Member Job Title Date Signature N.B. Copy to be given to parent/carer
To be completed by school: CONFIRMATION OF THE SCHOOL’S AGREEMENT TO ADMINISTER NON-PRESCRIBED MEDICATION I agree that (name of child): will receive (quantity and name of medicine): as detailed overleaf. This child will be given/supervised whilst he/she takes their medication by a member of staff. If a member of staff is not available to give/supervise the administration of this medication for any reason, the medication will not be given to the child and the parent will be informed. Name of Head Teacher/designated person: Signature: Date: CONFIRMATION OF STAFF’S AGREEMENT TO ADMINISTER NON-PRESCRIBED MEDICATION I have read this request for the school to issue non-prescribed medication in school and agree to administer as detailed above to this pupil. Staff Member Job Title Date Signature N.B. Copy to be given to parent/carer
App_3_Form_1_Non-prescribed_medication.docx