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© Hartford Primary School
| Medication Form |
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| Written by Administrator | ||||||||||||||||||||||||||||||||||||||||||||||
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HARTFORD PRIMARY SCHOOL REQUEST FOR THE SCHOOL TO GIVE MEDICATION Dear Headteacher, I request that ………………………………………………………………………… (Full name of pupil) be given the following medicine(s) while at school:
The above medication has been prescribed by the family or hospital doctor. It is clearly labelled indicating contents, dosage and child’s name in FULL. I understand that the medicine must be delivered to the school by myself or a named responsible adult. ……………………………………………………………………………………………………. and accept that this is a service which the school is not obliged to undertake and also agree to inform the school of any change in dosage immediately. Signed …………………………………………………………………. (Parent /Guardian) Address…………………………………………………………………………………………………………………………………………………………….. ………………………………………………………………………………………………………………………………………………………………………….. Date ………………………………………………………………… Authorised by...............................................................................
NOTE: Medication will not be accepted by the school unless this form is completed and signed by the parent or legal guardian of the child and that the administration of the medicine is agreed by the Headteacher. Pain killers will not usually be sanctioned. Antibiotics will only be administered if 4 daily doses are required. This agreement will be reviewed on a termly basis. The Governors and Headteacher reserve the right to withdraw this service. |
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| Last Updated ( Friday, 20 November 2009 ) | ||||||||||||||||||||||||||||||||||||||||||||||
