Field Trip Medication Administration Form
Download a blank fillable Field Trip Medication Administration Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Field Trip Medication Administration Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2DUBLIN SCHOOLS
DUBLIN UNIFIED SCHOOL DISTRICT
FIELD TRIP MEDICATION ADMINISTRATION
My child _________________________________ will be attending a field trip on _______________,
Student
Date(s)
from______________________ to____________________________________________________.
Time
Destination
I authorize:________________________________________ to administer medication(s) to my child
Teacher
while on the field trip. I will have a “Medication Administration Consent Form” completed and signed
by myself, and the physician for all medications to be administered during the field trip. Each
medication will be in a pharmacy labeled container, containing only the quantity needed for
administering during the field trip. All medications must be kept by the teacher.
Medication
Dosage
Time
Route
Precautions, special instructions, possible adverse side effects, or other comments:
For recording by teacher:
Administered by:___________________________ Time(s):_________________________________
Medication
Dosage
Time
Route
Precautions, special instructions, possible adverse side effects, or other comments:
For recording by teacher:
Administered by:___________________________ Time(s):_________________________________
Medication
Dosage
Time
Route
Precautions, special instructions, possible adverse side effects, or other comments:
For recording by teacher:
Administered by:___________________________ Time(s):_________________________________
Parent/Guardian Signature:____________________________________________ Date:_________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Education