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Parental agreement to administer medicine

The school/setting will not give your child medicine unless you complete and sign this form, 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

Parent/Carer Contact Details

I understand that I must deliver the medicine personally to Mrs Lea or Mrs Cook.

The above information is, to the best of my knowledge, accurate at the time of writing 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.