SAINT PASCHAL BAYLON SCHOOL

Instructions for Parent/Guardian:
If you are submitting this form for non-prescription medication only, you may complete and submit it online.

If you are submitting this form for prescription medication, please complete the form, then preview and print the PDF. Bring it to your Health Care Provider to complete and sign before submitting the finalized form to our office.

2025-2026 Regulations Regarding the Administration of Medication During School Hours

1. GENERAL POLICY

a) No student shall be given medications during school hours except upon the written request from a licensed physician who has the responsibility for the medical management of the student. All such requests must be signed by the parent or guardian.

b) Permission forms for students to receive medications (both prescription and non-prescription) while at school must be renewed each academic year.

 

2. RESPONSIBILITY OF THE PARENTS OR GUARDIANS

a) Parents or guardians will assume full responsibility for the supplying of all medications.

b) No medications may be brought to school by students.

c) Parents or guardians shall deliver or cause to be delivered by an adult or an authorized employee of a pharmaceutical supplier, any medication to be administered under the provisions of this policy.

 

3. RESPONSIBILITY OF THE PHYSICIAN

a) A request form for each prescribed medication must be completed by the student's physician, signed by the parent or guardian, and filed with the school administrator or their designated representative.

b) The container must be clearly labeled with the following information:
i) Pupil's full name
ii) Physician's name
iii) Physician's telephone number
iv) Name of medication
v) Dosage, schedule and dose form

4. RESPONSIBILITY OF SCHOOL PERSONNEL

a) Pupils taking medication will be assisted by authorized school personnel. This shall be done in accordance with the physician's

b) All medications administered by school personnel are maintained in a locked and secure place.

Please complete this form for all children who may require medication at school. Use the dropdown to enter each child's information.

I request that my child (children), named above, be assisted in taking the following medication at school by authorized SPBS personnel, and that he/she shall comply with the school's policies and procedures.

If your student DOES requires prescription medication to be administered at school, please preview and print the PDF using the link below.

You will need to take the printed form to your Health Care Provider to complete and sign before submitting it to the school office.

If your student DOES NOT require prescription medication but is able to take non-prescription medication at school, please submit below.

Note:

• A separate form must be completed for each sibling student requiring prescription medication, as child-specific doctor’s instructions are needed.
• This form must be completed annually.