SANTA ROSA CHRISTIAN SCHOOL

The giving of aspirin or other drugs or medications by school personnel is not recommended. However, upon the written request of a student’s parent/guardian, medication will be administered during school hours subject to the notes below. The medication must be in the original container. The school will NOT supply any medications.

ALL MEDICATIONS MUST BE LEFT IN THE SCHOOL OFFICE

Student’s name: ________________________________________________________________

Name of medication: ____________________________________________________________

Time (s) to be given at school: _____________________________________________________

Amount to be given: _____________________________________________________________

Reason for medication: __________________________________________________________

______________________________________________________________________________

I give my permission for school personnel to administer the above medication to the above named student.

______________________________________________________________________________

(Signature of parent/guardian)

Date: ___________________________ Telephone#: _________________________