MEDICATION ADMINISTRATION CONSENT FORM - Pendleton ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, date of birth, age, school, and grade in the designated fields. Ensure all information is accurate for proper identification.
3. List any known allergies in the provided section to inform school personnel of potential risks.
4. In the parent/guardian section, clearly print your name and provide your signature, telephone number, and date to authorize medication administration.
5. For the medication details, specify the name of the medication, reason for administration, dosage, time and frequency of administration at school. Select the method of administration from the options provided.
6. If applicable, include possible side effects and additional instructions to ensure safe medication use.
7. Finally, have a physician complete their section by providing their printed name, signature, and date to validate the medication request.

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