DAVIS SCHOOL DISTRICT MEDICATION FORM
Because of the legal implications involving teachers and others who administer medication to children, it is required that this form be completed by the parent and/or physician regarding any medication that needs to be administered during school hours. It is understood this creates no responsibility or obligation on the part of the school faculty and staff but is done only as a service to the parent or child.
Dear Mr. Owens of Davis High School:
I have read and understand the above paragraph and hereby authorize you or a member of your staff to give the medication listed below to the student named on this form. This will be done at my request and you or the staff member will not be held accountable for any effects nor the outcome of administration of the medication, nor shall you be held liable in any manner whatsoever for any act of negligence in giving such medication or for any failure to give such medication.