Medication Form

TATTENHALL PARK PRIMARY SCHOOL

In the event that you are unable to come into school to administer medication yourself, as a last resort you can request the school to give medication at the discretion of the class teacher.

Dear Headteacher

I request that ………………………………………………………………………………….. (full name of pupil) be given the following medicine(s) while at school.  I confirm it is not possible to amend the timings to allow the medicine to be given out of school hours.

Name of Medicine:                   ……………………………………………………………………………………….

Duration of Course:                  ……………………………………………………………………………………….

Dose Prescribed:                      ……………………………………………………………………………………….

Date Prescribed:                      ……………………………………………………………………………………….

Time(s) to be given:                  ……………………………………………………………………………………….

The above medication has been prescribed by the family or hospital doctor.  It is clearly labelled indicating contents, dosage and child’s name in FULL.

I understand that the medicine must be delivered to the school and collected by me or the under-mentioned responsible adult.  UNDER NO CIRCUMSTANCES MUST CHILDREN BRING MEDICINES INTO SCHOOL.

………………………………………………………………………………………………………………………………………………

and accept that this is a service which the school is not obliged to undertake and also agree to inform the school of any change in dosage immediately.

Signed:                                     ……………………………………………………………………………………….   (parent/guardian)

Contact Telephone No.             ………………………………………………………………………………………. 

Address:                                  ……………………………………………………………………………………….

                                               ……………………………………………………………………………………….

Date:                                        ……………………………………………………………………………………….

Notes to Parents:

  1. Medication will not be accepted by the school unless this form is completed and signed by the parent or legal guardian of the child and that the administration of the medicine is agreed by the Headteacher.
  2. This agreement will be reviewed on a termly basis.
  3. The Governors and Headteacher reserve the right to withdraw this service. 

Agreement of Staff Member:

I agree to administer the above.

Name:                                       ……………………………………………………………………………………….

Date:                                        ……………………………………………………………………………………….

Our Aims

For children:

  • Experience a broad and exciting curriculum that fosters creativity, independence, a passion and enjoyment for learning that continues throughout their lives.
  • Learn to value and respect themselves and others as individuals with equal rights and responsibilities.
  • Be given a strong foundation in their ethical and spiritual life to prepare them to be active and responsible citizens.
  • Be inspired by the environment in which they live and learn and to become stewards of it.
  • Be fit and healthy in body, mind and spirit and understand how to make good choices to keep safe and healthy.
  • Believe in their own abilities to develop resilience and a determination to achieve their potential.

Tattenhall Park Primary School, Chester Road, Tattenhall, Chester, CH3 9AH

Tel: 01244 981260 | Email: admin@tattenhallpark.cheshire.sch.uk