01246 850349

North Wingfield Road, Grassmoor, Chesterfield, S42 5EP

info@grassmoor.derbyshire.sch.uk

Grassmoor Primary School

Medicines

Please print off this form as needed and bring it to the school office with your child's medication.

 

PARENTAL CONSENT
FOR ADMINISTRATION OF MEDICINES IN SCHOOL

To be completed by the Parent/Guardian requesting medicines be administered under the supervision of school staff or where a child in bringing medicines into school which they will self administer.

Name of Child:  .....................................................................   Date of Birth:  ..........................................

Address:  ...................................................................................................................................................

Telephone Number:  .............................................................   Doctor:  ...................................................

Non Prescribed Medicines

My child requires the following non-prescribed medicines: 

...................................................................................................................................................................

...................................................................................................................................................................

Prescribed Medicines

The doctor has prescribed the following for my child:

Name of Medicine

When
eg lunchtime, after lunch, when wheezy

How Much
Eg teaspoon, tablet, drops

Route
Eg by mouth, ear

 

 

 

 

 

My child:    «. requires supervision to administer
                  «.. requires assistance in administering
                  «.. administer his/her own medication. (delete)

I agreed that the treatment be given in accordance with the above information by a first aid qualified member of staff.  Understand that it may be necessary for this treatment to be carried out during educational visits and other out of school activities, as well as on the school premises. 

I undertake to supply the school with the medicines in the original duplicate labelled containers, provided by the dispensing chemist. 

I accept that whilst my child is in the care of the school, the school staff stand in the position of parent and that the school staff may, therefore, need to arrange any medical aid considered necessary in an emergency, but I will be told of any such action as soon as possible.

The school will do it’s very best to ensure that it gives the medicine but will not take any responsibility if for any reason this does not happen.

I can be contacted at the following address/telephone during school hours.

Name:  ......................................................................   Telephone No:  ...................................................

Address:.....................................................................................................................................................

Signed:  .....................................................................   Date:  ..................................................................

Grassmoor Primary School

We are currently working on our new site.

With any urgent queries please contact our office at:

01246 850349

info@grassmoor.derbyshire.sch.uk