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💊 Student Medication Administration Form Template

School Year ______

As a parent, I understand that Seascape Academies' teachers can not administer medication to students (other than emergency life-saving medications). I am authorizing the following method of administration for my child:

Option A: Student Self-administration

I have discussed with my child the safety and dosage requirements of self-administering their medication, and I have reviewed and am familiar with Seascape Academies' Medication Policy.

Option B: Authorized Adult Administration

I have explained to the teacher (option B) about the procedure for administering the needed medications to my child and authorize him/her to administer the medication during school hours.

Option C: Parent Administration

I will administer medication to my child during school hours.

Preferred Option

A: Student Self-administration

B: Authorized Adult Administration

C: Parent Administration

Today's Date

Student Name

Parent/Guardian Name and Email

Parent/Guardian Signature

Signature