Parental Consent to Administer Medicine
This school/setting will not give your child medicine unless it is in accordance with our Supporting Pupils with Medical Conditions Policy and Procedures and you complete and sign this form.
PLEASE NOTE: Medicines must be in the original containers as dispensed by the pharmacy.
7. Medicine Date of Expiry*
12. Can the child self-administer?*
13. If YES to question 12 is supervision required?
14. Does any medicine need to be carried by the child on their person, what and where will they keep it?
20. I understand that I must deliver the medicine personally to a member of the OMG Administration Staff*
21. I understand that my child must have a working, in-date and sufficiently full inhaler, clearly labelled with their name, which they will bring with them every day.*
22. I consent to my child receiving, in an asthma emergency, salbutamol which has not been prescribed to them*
23. I understand that my child must have the number of working and in-date AAIs that their medical practitioner has recommended, clearly labelled with their name, which they will bring with them every day.*
24. I consent to my child receiving, in an anaphylaxis emergency, adrenaline not prescribed to them*
Declaration: The above information is, to the best of my knowledge, accurate at the time of writing and I consent to staff administering medicine in accordance with the Policy. I will inform the school/setting immediately, in writing, if there is any change in dosage or frequency of the medicine or if the medicine is stopped.
