Permission for Medication Administration Outdoor Education

The parent/guardian of asks that properly trained and delegated school staff give to my child according to the Health Provider’s signed instructions on the lower part of this form.

The School agrees to administer medication prescribed by a health care provider licensed in the state of Colorado. It is the Parent/guardian’s responsibility to furnish the medication and to complete and submit the requested information.

The parent agrees to pick up expired or unused medication within one week of notification by staff.

Prescription medications must come in a container labeled with: child’s name, name of medicine, time medicine is to be given, dosage, and date medicine is to be stopped, as well as the licensed health care provider’s name. Pharmacy name and phone number must be packaged in the original container. For Outdoor Education, 3 doses of extra medication may be provided.

Over-the-counter medications must be labeled with child’s name and prescribed information. Dosage on the container must match the signed health care provider authorization. Medicine must be packaged in the original container.