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  • Attending school is crucial for young children's learning, socialization, and future success
  • Attending school helps young children develop cognitive and social skills, fosters curiosity, and sets the foundation for future academic and personal success.
  • Regularly missing school can lead to a significant gap in a child's education, affecting their academic progress and future opportunities.
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Medical Consent Form

Parents Pages

The school will not give your child medicine unless you complete and sign this form.

Parental agreement for Rothwell School staff to administer medicine

Date for review to be initiated by
School Name:*
Nursery
Infant School
Junior School

Details of Pupil

Surname
Forename(s):
Date of Birth
Boy or Girl
Boy
Girl
Class
Condition or illness:

Medication: Parents must ensure that in date, properly labelled medication is supplied.

Name/Type of Medication (as described on the container):
Add a photo of the prescription box label (showing dosage and patient name) *
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Date dispensed:
Expiry date:
Full Directions for use (Dosage and method)
Timing/Frequency:
Special precautions
Are there any side effects that the School needs to know about
Can the child administer this medicine themsleves?*
Yes
No
Procedures to take in an emergency

Note that medicines MUST be in the original container as dispensed by the pharmacy

Parent/Carer details and agreement

Parent Name
Daytime Phone Number
Your Email Address *
Relationship to child
Address
I understand that I must deliver the medicine personally to (agreed staff member name):
The above information is,To the best of my knowledge, accurate at the time of writing and I give consent to the school staff administering medicine in accordance with the school policy. I will inform the school immediately, in writing, If there is any change in dosage or frequency of the medication or if the medicine is stopped.
Yes
No
Date
Please upload a copy of your signature (use mouse, stylus or fingertip)
Clear
Submit