Over-the-counter medication request form

Please indicate the medications for which you are giving consent to be administered to your child at school. Dosage given will be administered per age and weight instructions on medication container unless other instructions are written below. These medications will be administered on a prn (as needed) basis.

If your child needs to take any other over-the -counter medications at school besides those listed above, please complete the following:

This student has received at least one dose of this medication in my presence and has not suffered any adverse reactions from this medication. I understand that the school employee who administers this medication to my child in accordance with the written instructions above shall not be liable for damages suffered by the student as a result of an adverse reaction to the medication.