Parental Agreement For Hilltop School
To Administer Medicine

* A paper copy of this form can be requested from the school office *

    We cannot give your child medicine unless you complete and sign this form.

    Note: Medicine must be in the original container as dispensed by the pharmacy with a clear label,in date with your
    child’s name
    The above information is, to the best of my knowledge, accurate at the time of writing.
    By completing this form, I give consent to Hilltop school staff administering medicine.
    If there is any change in dosage /frequency or the medication has stopped, I will inform school immediately.
    Note: If your child comes to school on transport, can you make sure you hand over & receive medication from the escort.
    If more than one medicine is to be given, a separate form must be completed for each one.