EE2b Medication Forms - Please Hand in with Medication

EE2b Medication Forms were issued to pupils who indicated on the EE2 form that they will require medication at Benmore.

EE2b forms should be handed to the Class Teacher on Monday 9th February with any medication (clearly labelled in a transparent plastic bag). Additional EE2b forms will be available.

The information on the EE2b we require to accompany medication is:

Out of School Medication, Medical Treatment and Medication Recording Form EE2B

Dear Parent/Carer,

You have indicated on your child’s EE2 form that he/she will need to take medication or receive medical treatment while on the school excursion to Benmore on  9th-13th February 2015

Please complete the medication table below giving the name of each medication as it is written on the pharmacy label. If you want your child to be responsible for taking and carrying their own medication (Secondary school pupils only) please sign the box as indicated for each medicine. Please make sure the medicine that is given to the school is in the container in which it was dispensed, clearly labelled with the contents, dosage and child’s name in full. Any liquids must be given in an unopened bottle.

Pupil’s name _______________________________________ Date of Birth ________________

	Name of Medication (if a different dose is given at another time please complete a separate box for each dose)	Dose	Time(s) to be given	Quantity supplied to school or sign box if child is to be responsible for taking that medication
1
2
3
4
5
6

I accept responsibility for ensuring that the medicine has not expired and that there will be enough medicine supplied to the school for my child’s needs.

Name of Parent/Carer __________________________________

Signature of Parent/Carer _______________________________________ Date ____________

Out of School Medication, Medical Treatment and Medication Recording Form EE2B

Please give details of your child’s medical condition and the treatment that they will require in the space below.

Details of Medical Condition	Details of Medical Treatment

I accept responsibility for ensuring that the details I have supplied are correct and that any product that has been supplied has not expired and that there will be enough supplied to the school for my child’s needs.

Name of Parent/Carer __________________________________

Signature of Parent/Carer _______________________________________ Date ____________