Medication in school

Please use this form to let us know if you wish your child to be given any prescribed or non-prescribed medicine whilst in school.  Medicine must be handed in to the school office who will check whether a form has been completed.  We will not administer any medicine without a valid form completed. 

All medicines must be clearly labeled, in date and in the original packaging. 

The school medicine policy is available on our website.

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Child's Name *

Child's Year Group *

Nursery Reception Year 1 Year 2 Year 3 Year 4 Year 5 Year 6

Medical condition or illness *

Name / Type of medication (as described on the packaging) *

Where does the medicine need to be stored *

Start date for medication to be given *

 

End date for medication to be given *

 

Dose to be given *

Time to be given *

 

Possible side effects (if any)

Procedure to take in an emergency *

Please tick this box if your child can self-administer this medicatifcation. *

Parent / Carers signature *

Please provide a signature. *