Preparing Children for a Successful Future
Clifton with Rawcliffe School
Parent/Guardian agreement for school/setting to administer medicine
The school/setting will not give your child medicine unless you complete and sign this form,
and the school or setting has a policy that the staff can administer medicine.
Name of school/setting
Name of child
Date of birth
Learning Group
Medical condition or illness
Name/type of medicine
(as described on the container)
Quantity received
(eg half bottle)
Dosage and method:
Timing:
Special precautions / Storage details:
Date dispensed: Expiry date:
Are there any side effects that the school/setting needs to know about?
Procedures to take in an emergency:
Self administration:
