Useful Forms | Cherry Tree Academy Trust

EXCEPTIONAL CIRCUMSTANCES TIME AWAY FROM SCHOOL IN TERM TIME

ABSENCE NOTIFICATION

ADMINISTRATION OF MEDICATION FORM

NAME OF CHILD

Max length 120 characters

NAME OF CLASS

Max length 120 characters

NAME AND STRENGTH OF MEDICATION

Max length 500 characters

EXPIRY DATE OF MEDICATION

DOSE TO BE GIVEN

Max length 120 characters

TIME MEDICATION TO BE GIVEN

Max length 120 characters

ANY OTHER INSTRUCTIONS

Max length 500 characters

NUMBER OF TABLETS / QUANTITY TO BE GIVEN BY ACADEMY STAFF

Max length 120 characters

DAYTIME CONTACT PHONE NUMBER OF PARENT OR FAMILY MEMBER

Max length 120 characters

NAME AND PHONE NUMBER OF GP

Max length 500 characters

AGREED REVIEW DATE

The above information is, to the best of my knowledge accurate at the time of writing. YES / NO

Max length 120 characters

I consent for the staff of Cherry Tree Academy to administer the medication as instructed above and

Max length 120 characters

I will inform the academy, immediately, and in writing, if there is any change in dosage or frequenc

Max length 120 characters

LOGGED EMAIL ADDRESS

COLLECTION FORM