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Darley Dene Primary School

Pupil Medication Request

Where possible the need for medicines to be administered at school should be avoided. Parents are therefore requested to try to arrange the timing of doses to avoid lesson time and the subsequent impact on your child's learning. Please note, when medication is prescribed 3 times per day we will not be able to administer at school as this can be achieved outside school hours.

We will administer medicines to your child during their lunch break only. Only in exceptional circumstances will medicines be given outside these times and must be discussed with the office in advance.

Please tick the appropriate box:*

I agree to update information about the child's medical needs held by the school and that this information will be verified by GP and/or medical Consultant. I will ensure that the medicine held by the school has not exceeded its expiry date.

Please record below the medication you wish your child to receive while at school.
Please note that if no completion date is recorded medicine will only be given to your child on the first day the form is submitted to the school office.

 Name of medicineDoseTime requiredCompletion dateExpiry date of medicineOFFICE USE ONLY: administered by (initials)
Medicine 1
Medicine 2
Medicine 3


Parents/Carers of Early Years children
By signing below I acknowledge that the requested medication was administered to my child:

Darley Dene Primary School