RIVER HOUSE MONTESSORI SCHOOL
REQUEST FOR THE SCHOOL TO ADMINISTER SHORT TERM MEDICATION

Name of child
Condition or illness for which medication is required
Name/type of medication (as described on the container)
Length of time in days for which the medication is to be administered
Date medication dispensed

Dosage and method

I confirm that the contact details which I have given to the school are up to date. I understand that in the event of an emergency the school will use these details to contact me and will also, if necessary, take my child to hospital or call an ambulance.

I understand that I must deliver the medicine personally to the agreed member of staff and accept that administration of medication is a service which the school is not obliged to undertake.

Signature........................................................

Relationship to the child..............................

Date.................................................................

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If you wish the school to administer medication to your child please print this form, complete it and bring it to the school with the medication.The school will not give your child medication without a completed and signed form and unless a member of the senior management team has agreed that school staff can administer the medication. The school will only administer medication which has been prescribed for the child by a medical practitioner.

Timing and frequency
Special precautions
Possible side effects

Member(s) of staff designated to take
responsibility for administering the medication ...............................................................................

Agreed by a member of the senior
management team


Name......................................... Signature............................... Date..................................