Medication Authorization Form

If a student must take medication he/she should do this at home whenever possible.  In the event a student must take medication at school, proper written consent must be given to school personnel to administer the medication.  Please note the following:
  • No medication including prescription, over-the-counter, or herbal remedies will be administered by school personnel or its agents until the consent forms are completed and on file with the school.
  • All medication must be in the original container.
  • All prescription medication must have a pharmacy label including the student’s name, correct dosage, and time(s) to be given.
  • Parents are responsible for bringing medication to the school and picking up unused medication within 10 days after the medication has been discontinued.
  • Students are not allowed to transport their own medication.  It must be brought to school by the parent or guardian.
  • School personnel may not cut tablets. If your child needs to receive half a tablet cut the tablets at home or have the pills cut at the pharmacy filling the prescription.
  • Please notify the school immediately, verbally and in writing, if there are any changes to your child’s prescription.
The school may refuse to administer, or allow to be administered, any medication, which, based on her/his assessment or judgment, has the potential to be harmful, dangerous or inappropriate.  In these cases, the school shall notify the parent/guardian and licensed prescriber and explain the reason for refusal.
Please take the form below to your child’s pediatrician to be completed.  Each medication requires a separate form.  Bring the medication authorization form and the medication to the first day of school.
If you have any questions, concerns, or need information about medication administration at school, please feel free to contact the front office and ask to speak to the school nurse.

Download Printable Version (PDF, 600KB)

Questions? Contact the school here.

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