OTC Medication 2024-25

2024-25 Medical Permission for OVER THE COUNTER Medication
BCHS does not provide your child with school purchased over the counter medications, such as Tylenol, ibuprofen, cold medicines, cough drops, etc. If your child has a need for over the counter medication(s) during the school day, we expect them to take the medication under the supervision of the school nurse.

Each family must provide their own supply of all/any medications listed on this permission form. Medications must be in the original bottle and will be stored in the Nursing office.

This form's permission is for NON-Prescription, over-the-counter medicines only and is valid for the 2024-25 school year only.

(For prescription medications, you must fill out the Prescription Medicine Medical Permission Form)
Student's Name*

First NameMiddle NameLast Name
Birthdate*

MonthDayYear
Date
Non-Prescription Medication Information
Medication(s)*
Dosage(s)*
Time(s) to be given*
Reason for taking the medication*
What time does the student take this medication at home?*
If medication is to be given at school 'as needed', describe the indications for administration and frequency of dose:*
Is the medication permission needed for the entire school year?*

YesNo
The medication should be taken from Enter Starting Date* to Enter Ending Date*
Please enter parent/guardian initial below. This is required by law to be able to send home medications.
Send the medication home with my student Enter INITIALS here*
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent / Guardian Email*
For parent/guardian verification, please enter the email used in the parent/guardian PowerSchool account. We will send a notification to this email and cross-check with PowerSchool info.
I, as parent/guardian of the above student, understand that Bishop Chatard High School is not responsible for ensuring that the above medication is taken and is relieved of responsibility for the benefits or consequences of the child/youth using or not using the medication described above.
Typed Signature*
Parent/ Guardian Signature*

Clear
Use your finger or mouse to sign here
Today's Date

MonthDayYear
Date of Signature
Should be Empty:

2024-25 Medical Permission for OVER THE COUNTER Medication

Non-Prescription Medication Information

Parent/Guardian Information