THE SCHOOL DISTRICT OF VOLUSIA COUNTY HEALTH 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, school, and grade in the designated fields under the Parent's Statement section.
3. Indicate your permission for the student to self-administer medication by checking 'Yes' or 'No'.
4. Provide your signature and date in the Parent/Guardian Signature section, along with your address and contact numbers.
5. In the Doctor's Authorization section, ensure that the physician fills out the required information regarding medication dosage and frequency.
6. The doctor must also note any possible reactions or side effects and provide a reason for administering medication at school.
7. Finally, ensure that both the doctor’s signature and stamp are included before submitting the form.

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