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Medication indemnity form.

Please note:
a) We are only able to administer medication if it has been prescribed by a Doctor. This includes Piriton and Calpol.
b) Medication must be given to the main office. Do not leave it in your child's bag.

Child's name:

First

Last

Child's class:

Child's date of birth:

Medication name:

Time of first dose:

Time of second dose (if necessary):

Does required (e.g 5ml):

Parent's name:

First

Last

By completing and submitting this form, I wish the Headteacher of Crawley Green Infant School or a deputy nominated by them, to administer medicine to my child in accordance with the official instructions supplied therewith and in consideration thereof I hereby undertake to supply the necessary medicine and instructions to the Headteacher and to indemnify and hold harmless the Headteacher, their deputy and Governors against claim of any nature whatsoever arising from the administration of the medication.