PARENT/STUDENT

If you need any assistance with PowerSchool login information, please reach out to Mrs. Gonzalez at [email protected] or Mr. Tuang at [email protected] .

NEED MEDICATION ADMINISTERED?

If you are needing your child to be administered any medication, please fill out the following form and turn into the front office. You are also able to email this form completed to Mrs. Gonzalez or Mr. Tuang .

MEDICAL RELEASE FORM

* Indicates required field

Parent Name *

First

Last

Email *

Student Name *

First

Last

Medication Name *

Time(s) & Amount to Administer *

I hereby give permission for school staff members to administer medication during school hours, in accordance with my enclosed written instructions. I agree to provide all medication in the original container from the pharmacy and to renew long-term medication orders at the beginning of every school year.

Signature *

First

Last

Submit

NEED MEDICATION ADMINISTERED?

MEDICAL RELEASE FORM

ADDRESS

CONNECT