The school/setting will NOT give your child medicine unless you complete and submit the form below, and the school or setting has a policy that the staff can administer medicine.

NB: Medicines must be in the original container as dispensed by the pharmacy.

The above information is, to the best of my knowledge, accurate at the time of submitting, and I give consent to school/setting staff administering medicine in accordance with the school/setting policy. I will inform the school/setting immediately, in writing, if there is any change in dosage or frequency of the medication or if the medicine is stopped.