Request for the Archer Academy to Administer Medication

Request for the Archer Academy to Administer Medication
The Archer Academy cannot administer medicine to your child, or allow your child to self-medicate, unless you complete and sign this consent form. The medication has to be prescribed by a medical professional and the Headteacher or a member of the Senior Leadership Team has to agree that this can be administered. Parents are responsible for ensuring that medication is within expiry date. Medication that has expired will be disposed of. A separate form is required for each medicine.
Student Name

First NameLast Name
Tutor Group
Condition or illness
Medication

Medicine must be in the original container as dispensed by the pharmacy and it must be in date, labelled and state dosage instructions. Medicine which does not meet these criteria will not be administered.

A maximum of one academic year’s supply of the medication may be provided to the school at one time.

Medication required 3 times a day can be taken before school, after school and at bed time and does not need to be in school.
Name/type of medication (as described on the container)
Date dispensed

DayMonthYear
Date
For how long will your child take this medication:
Dose, frequency and timing:
Special precautions:
Side effects:
Any other instructions:
Procedures to take in an emergency:
Name and phone number of GP:
Contact phone numbers of parent/carer
Parent Signature

Clear
Date

DayMonthYear
Date
Should be Empty: