St. Thomas More St. Thomas More Catholic Catholic Catholic School

Report 0 Downloads 12 Views

St. Thomas More Catholic. Catholic. Catholic School. Chapel Hill, NC. Over-the-Counter Medication Permission Form. **To be completed by a Parent**.

St. Thomas More Catholic School Chapel Hill, NC Over-the-Counter Medication Permission Form **To be completed by a Parent** Student’s Name_________________________________________________ Class_________________ Medication: Please check each box for the medication you give permission to. Please circle the appropriate dosage as well (how many tabs or teaspoons).

__Tylenol (Acetaminophen)

160 mg/tab (one) (two) tabs 325 mg/tab (one) (two) tabs

__Motrin (Ibuprofen)

100 mg/tab (one) (two) tabs 200 mg/tab (one) (two) tabs

__Benadryl (Diphenhydramine)

12.5 mg/tsp (one) (two) tsp

__TUMS (Calcium Carbonate)

400mg/tab

(one) (two) tabs

Other: _______________________ Dosage _________________ Dates to be given: From______________________ to ________________________ Times to be given:

_______AM

________PM ______ As Needed

This form will allow the nurse to provide “over the counter” (OTC) medications listed above on an occasional basis to your child. If the named medications are needed on a regular basis, please provide that “over the counter” medication in the original container with the student’s full name written on it. I hereby give permission for my child (named above) to receive the above-mentioned medication during school hours. I understand that the school undertakes no responsibility for the effects of this mediation when it has been properly administered. I hereby release St. Thomas More School and their employees and agents from any and all liability that may result from my child taking the above named medication(s), according to the written instructions I have given. Parent/Guardian Signature __________________________________________________ Date_____________

Recommend Documents
St. Thomas More Catholic. Catholic. Catholic School. Chapel Hill, North Carolina. Request for Prescription Medication to be Given during School Hours.

St Thomas More Catholic School. St Thomas More Partnership of. Schools. Year 7 Target Setting Evening. Thursday 22nd September, 2016. St Thomas More ...

"Columbarium" means a durable, fireproof structure containing niches and used or intended to be used to contain cremated remains. C. “Columbarium and ...

Oct 2, 2017 - This is an exciting time to join the school where positive change is taking place. HMI said Thomas More Catholic School: • Are making ...

May 8, 2017 - Thomas More Catholic School. COMPLAINTS POLICY. Mission Statement. To Care for, respect and value all people and our environment.

Persistent lateness after registration has closed constitutes the same offence for parent/carers as non- attendance and will therefore be dealt with in the same ...

Pork Patty in a bap. Vegetarian. Spicy Bean Burger. Dessert. Pineapple upside-down Cake. Thursday. Main meal choice 1. Creamy Chicken Korma with Rice.

As a Catholic School, when referring to entry for Roman Catholic children, ... rite of the Roman Catholic Church or in accordance with the rite of another Church ...

Throughout their time in Thomas More Catholic School all members of our ... Catholic liturgy and practice and there is plenty of support at hand for this.

Cheese and Onion Pasty. Dessert. Jelly or Cheese and Biscuits. Made in your school kitchen! We prepare and cook all our menu items, so if you need to know ...