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Student Medication Form

Student Medication Form
  • The school nurse (or designee) has my permission to take a photograph of my student for identity purposes.

  • I certify that at least one dose of the medication has previously been given and NO adverse reactions were experienced. Therefore, I give permission for the school nurse (or designee) to administer the above medication to my child.

    For an oral controlled substance, in the unavailability of a school nurse, the parent delegates the following designee to administer the medication at school.

  • I acknowledge that the school, its Board, and its employees shall be immune from civil liability for damages resulting from the administration of medications in accordance with this consent form.

    The electronic signatures below and their related fields are treated by Arkansas Christian Academy in the same regard as a physical handwritten signature on a paper form.

  • Note: Medication MUST BE in current original container from the pharmacy. The medication will only be administered according to the physician’s directions on the container