Medication Authorization Form

The Michigan Department of Education, "Model Policy and Guidelines for Administering Medications to Pupils at School" requires that parents/guardians update their child's medication forms at the beginning of every school year.  It is important to your child's well-being that these forms be completed and returned to the school office prior to the first day of school.

                                            Procedure for the Delivery of Medication

Prescription - All prescription medication received at the school must be in the original pharmacy labeled container showing the dosage.

Over-the-Counter Medication - Over the counter medication must have the child's name clearly written on the label.  The physicians order including the dosage is required.

If school personnel will be responsible for administering medication to your child, complete the Medication Authorization Form-Physician/Parent Signature (Yellow) 

  1. The form must be completed and signed by the physician.
  2. The parent/guardian must sign the form.
  3. Return the form to your child's school office along with any listed medication(s).    
    - Medication will not be administered by any school personnel,
      beginning with the 1st day of school, if the completed paperwork
      is not on file with your child's school.

    PDF DocumentMedication Authorization Form