Medication FormShort/Long Term Medication Form Child's Legal Name * Forenames and Surname First Name Last Name Child's Date of Birth * MM DD YYYY Child Class * Medical condition or illness * Name and Strength of medication * Number of tablets provided (Long Term Medication box required) Dose/Frequency of medication * Expiry Date * MM DD YYYY I allow the school to adminster this medication * Yes No Thank you, your application has been received.
