MEDICATION ADMINISTRATION AUTHORIZATION

I, the undersigned parent or guardian of ______________________________request the assistance of the First Baptist Church School in administering medication to my child.

I request that medication for my child be kept under the control of the principal, office staff, or homeroom teacher, and that it be made available to my child.

I realize the school can in no way accept any responsibility for the administration of any medication to the above named student nor for any condition resulting from the child's failure to procure such medication.

The child and I accept full responsibility for such medication and for the administration of the medication to the child.

Please list any known allergies:

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SCHOOL MEDICATION POLICY

In order for the school to comply with the school committee policy, the following procedure should be followed when a student takes medication at school.

1. Parents must complete this form. If medicine is to be given longer than 10 days (long-term medication) the doctor's signature must be entered on this form.
2. All medicines given by school personnel must have a label including the student's name, the name of the drug, instructions for taking the medication and (when applicable) the doctor's name. Medication must be in the original container.
3. Only the amount of medication required at school should be sent to school.

PARENTS- Please fill out the following information

Signature of Physician giving authorization to administer medication(s) longer than ten days.

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Signature of Parent or Guardian______________________  Date _______________