Request to Administer Prescribed Medication Form

We collect and process all personal data in line with our privacy notices which can be found on the policies page of our website.

Please complete all fields marked (*)

Your first name *

Your last name *

Your email *

Your first name *

Your last name *

Your email *

Your mobile number *

Your relationship to the child *

Child's first name *

Your child's last name *

Child's date of birth *

 

Child's class *

Medical condition or illness *

Name of medication (as described on container) *

Expiry date *

 

Dosage and method *

Time medicine is required if applicable *

 

other

Are there any side effects that the school needs to know about? *

Procedure to take in an emergency *