Download/Print Copy of Non-Prescription Medication
Belgrade District School Permission For Non-Prescription Medication To Be Taken At School
Download/Print Copy of Non-Prescription Medication
- Name of Student
- Grade
- Teacher
- Mother's Daytime Phone
- Father's Daytime Phone
- Name of Medication
- Purpose of Medication
- Time of Day or How Often Medication May Be Taken
- Possible Side Effects
- Anticipated Number of Days Medication Needs To Be Taken At School
- Additional Instructions
I hereby give my permission for [student's name] to take the above medication at school as stated. I understand that it is my responsibility to furnish this medication.
- Signature of Parent or Guardian
- Date