Medication Dispensing Release at School MA - Medication Dispensing Release For School Name First Last This is to authorize and direct Miriam Academy staff to give my child medication at school. I certify that such medication has been prescribed for my child by his/her doctor and I give permission for sufficient amounts of this medication to be kept at school and dispensed to my child, as directed, during the school day.Medication at School* Yes NoSchool Medication 1# of tablets, etc.Time administeredDirectionsSchool Medication 2Dosage# of tablets, etc.Time administeredDirectionsSchool Medication 3Dosage# of tablets, etc.Time administeredDirectionsSchool Medication 4Dosage# of tablets, etc.Time administeredDirectionsSchool Medication 5Dosage# of tablets, etc.Time administeredDirectionsSchool Medication 6Dosage# of tablets, etc.Time administeredDirectionsSchool Medication 7Dosage# of tablets, etc.Time administeredDirectionsParent / Guardian Signature* First Last Date* Date Format: MM slash DD slash YYYY Pin Number*CAPTCHA
