Medication Administration

Please fill out the form below to empower The Forest School staff to administer medicine to your learner at school.

Please Note: Prescription Medication must come in a container labeled with: child’s name, name of medicine, time medicine is to be given, dosage, date medicine is to be stopped, and licensed health care provider’s name. Pharmacy name and phone # must also be included on the label. Over the counter medication must be labeled with child’s name and dosage amount clearly marked. Medicine must be packaged in original container.

Name of learner who will receive medication *
Name of learner who will receive medication
I affirm the following... *
Affirm your willingness for your The Forest School staff to administer medicine to your learner by checking all three boxes below:
Today's date *
Today's date