Parent / Legal Guardian Medication Consent

Staff can administer medication to a child only when the parent/guardian has submitted this form completed and signed. All medications must be in the original container. If your child requires an inhaler – the top part of the form will permit staff to administer the inhaler on a set schedule or at the child’s request. If you wish your child to carry the inhaler or epi-pen on their person or self-administer, the second portion of this form with an attached written procedure is required. If medication is to be administered on an “as needed” basis, the written instructions must clearly indicate the situations under which the medication should be given. This could include the physical symptoms that must be present, the behaviour the child must be exhibiting or the child’s temperature. If your child requires an epi-pen, please also complete the Individual Anaphylaxis Plan .