Administering medicine

Please enter your child's first name* Please enter your child's surname* Please enter your child's class* Please enter your child's date of birth* Please enter medical condition/Illness* Please upload supporting doctor's notes if possible No file chosen Please enter medicine name* Please enter medicine expiry date* Please enter dosage* Please enter timings and frequency* Please enter the method (tablet, syringe)* Special precautions/other instructions* Please enter any side affects that the school need to know about.*

Is the child able to self administer ?*YesNo

Emergency contact name* Emergency contact email address* Emergency contact number* Emergency contact alternative number*

I hereby acknowledge by completing this form, it is to the best of my knowledge, accurate at the time of writing and I am giving consent to school/setting staff administering medicine in accordance with the school/setting policy. Please note that we can only accept forms submitted by individuals listed with parental responsibility. Please bring all medication to the school office in the morning.*I Hereby agree to the above statement

Name of guardian agreeing to the above statement*