Medication Administration Consent Form
Student Information
Full Name
Date of Birth
Grade/Class
Parent/Guardian Information
Name
Contact Number
Medication Details
Medication Name
Dosage
Time(s) to be administered
Route
Duration (e.g., days, weeks)
Reason for Medication
Special Instructions
Instructions/Precautions
Consent
By signing below, I give permission for the above medication to be administered to my child as directed.
Parent/Guardian Signature
Date