Health Services Parent Permission for Student to Self-Administer Non-Prescription Medication

ST. JOHNS COUNTY SCHOOL DISTRICT

Rev. 06/2022

Overview

School Board Policy 5.15 – Administration of Medication during school hours, states that “all prescription and non-prescription medication administered by the school at the elementary, middle and high school level must be directed by a physician who has determined that a student’s health and well-being requires medication during school hours. All non-prescription medication in the possession of students at the middle and high school, not administered by the school, requires written permission from the parent to the school.”

To comply with School Board Policy 5.15, parents/guardians are responsible for obtaining the Medication Authorization Form to be filled out by the physician if medication will be given by the school. For those students carrying non-prescription, non-emergency medications, the parent/guardian is responsible for completing the Parental Permission Form at the bottom of this letter.

Policy Details

School Board Policy 5.15 – Administration of Medication During School Hours, states that a student at the middle and high school level may carry a non-prescription, non-emergency medication on his or her person while in school with approval from his or her parent/guardian.

Over-the-counter medications must be in the original container.

Permission Form

I give permission for the below named child to carry and self-administer his or her own non-prescription, non-emergency medication. I understand that my child may not share his or her medication under any circumstance and that a copy of this permission form must accompany the stated medication. I understand that if there is inappropriate behavior or a safety risk, the privilege of carrying his or her medication will be rescinded.

Student Name	Grade	Homeroom
[Student Name]	[Grade]	[Homeroom]

Name of non-prescription, non-emergency medication: [Medication Name]

Reason for medication: [Reason]

Parent/Guardian Signature: ______________________

Parent/Guardian Printed Name: ______________________

Date: ______________________

I understand that I am not to share my medication under any circumstance and that a copy of this permission form must accompany the above medication.

Student Signature: ______________________

Student Printed Name: ______________________

Date: ______________________