OES Permission for Administering Medications on Trips

Children sometimes need to receive medications while on field trips. Requirements for medication administration vary by division.
    - Lower School: All medication must be administered by an adult.
    - Middle School: Students may carry inhalers/Epipens/migraine meds only; other medications must
      be administered by an adult.
    - Upper School: Students may carry most medications except prescription pain medicines,
      psychiatric medications, learning disorder medications.
Which division is this trip for? *
Is this an overnight trip with an OES sports team? *
Please document on this form all medications that your child will be taking while on the field trip and which need to be administered by an adult as outlined above. Two medications per sheet can be listed.
     - PRESCRIPTION medications require written instructions from a physician and written permission from the parent or guardian. This requirement is met by filling in the information below and bringing the medicine in the original pharmacy container labeled with the child’s name, dosage and frequency to be given.
     - NON-PRESCRIPTION medications require only written permission from the parent or guardian. This requirement is met by filling in the information below. Medication must be in the labeled commercial container.
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Medication #1

OR
1. (check the box)

Medication #2

OR
2. (check the box)

Medication #3

OR
3. (check the box)

Medication #4

OR
4. (check the box)

Authorization and Electronic Signature

Oregon Episcopal School has my permission to administer the above medications to my child accroding to the above instructions as indicated by my electronic signature below:
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