THIS PORTION TO BE COMPLETED BY PARENT/GUARDIAN
I am the parent/guardian of the above student and have lawful custody of said child. I hereby give consent to designated school personnel to administer medication and/or treatment as specified by his health provider. Furthermore, I hereby give consent to the school to receive from or send to the health care provider any information concerning my child’s medical condition. In the event that the school grants my child permission to carry and self-administer medication(s), a separate, contractual agreement of responsibilities must be signed by student, parent, physician, and school official.