This form is to be completed by the student's physician and parent for ANY medication to be administered at school.

This form allows students, with parent permission, to self-administer emergency medication. JHCD FORM-3 must accompany this form.

Parents should complete this form each year to provide the school nurse with the most up to date health information on thier student.

This form may be taken to your physician when your child has a physical. Return the completed form to your school nurse.