Student Medication Authorization

 
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 Student Medication Authorization  
Please complete this form regarding any medications that need to be dispersed by the school nurse during the school day. Parents should inform the school nurses of any medication change. If medication is added at a later date, please email the school nurse (nurse@woodlandschool.org) to request a Student Medication Authorization form. Please include any over the counter medications that your student may need during a school day such as Tylenol, Advil/Motrin, Tums or Benadryl.

 
 
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(amount to be given)
 
   
 
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If medication is to be given as needed, please describe symptoms.
 
   
 
 
   
  Medication should be administered at home rather than at school whenever possible. If medication from home must be administered at school, parents are required to sign this medical authorization form and send the medication in its original, pharmacy labeled container.

All over the counter medications (OTC) that your child may require must be provided by the parent and have a signed medication authorization on file.

I understand that my child will be assisted in taking the medication(s) described above at school by the school nurse or authorized person(s). The undersigned agrees to release, indemnify and hold harmless Woodland Presbyterian School, its employees, or representatives from any claim, liability, or expense arising out of or in any way connected with the giving or failure to give prescribed medication to my child. This release and indemnity agreement includes claims based on alleged negligence on the part of Woodland Presbyterian School or its employees. In addition, I agree that it is my responsibility to inform the school nurse, in writing, of any change in medication and/or its distribution to my child.

I/We grant Woodlan Presbyterian School all authority and permissions indicated on this form by my/our selections. I/We understand that all authority and permission granted hereunder shall be valid and enforceable until specifically rescinded in writing by the person(s) signing this form.


AGREEMENT: By signing this Electronic Signature Acknowledgement Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

By signing below, I accept the conditions of this agreement.
   
 
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