Medical Consent form

This medicine will be given as prescribed by an appropriately trained member of staff while your child is at school until you inform us that it is no longer required. If your child's dose/strength changes, or if this medication is stopped, please contact your school's nursing team as soon as possible.

First name (of child)* Surname (of child)* Date of Birth* School* Medication* I confirm that I, the person with Parental Responsibility, give permission the the child name above to receive the following medication whilst attending school (Please enter your name)* Contact phone number* Email address*

Please answer the following:*
	Name of medication	Strength of medication	Dose to be given	Route to be given (e.g. Orally, topically, via gastrostomy etc.)	Time to be given