MEDICATION DURING SCHOOL HOURS, PHYSICIAN PARENT SIGNATURES HOLD HARMLESS PERMISSION FORM JULY 2004 -2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your child's name and birth date in the designated fields. This ensures that the medication is correctly associated with the right student.
3. In the section for physician's instructions, have the physician complete all necessary details including diagnosis, medication name, dosage, and administration times. Ensure this information is accurate for safe medication administration.
4. As a parent/guardian, provide your signature and date in the appropriate fields to authorize the school to administer the medication as per the physician's instructions.
5. Fill in your contact information including daytime phone numbers and email address. This allows school personnel to reach you if there are any questions or concerns regarding your child's medication.
6. Finally, ensure that you deliver the medication in its original container with proper labeling as specified in the form's notes.

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