Providence Academy

FORMS

Authorization for
Administration of
Medication at School

Middle/Upper School
Medication
Authorization Form

Medication Authorization Forms

Choosing the appropriate form:
o       The Authorization for Administration of Medication
         at School form is required for:
               ·        prescription medications taken during school
               ·        over-the-counter medications that your child
                       may need on occasion

*Please note this form requires parent and physician signature.

o       For students in grades 6 – 12, you may use the
         Middle/Upper School Medication Authorization Form
         for acetaminophen (Tylenol) or ibuprofen (Motrin, Advil)
         only.

*This form requires parent signature.

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