Activity or Field Trip Medication Instruction Form 7.270 F6

The Activity or Field Trip Medication Instruction Form is used to provide District 158 staff members permission to administer prescription or non-prescription medication to students attending a school sponsored activity or field trip (including overnight trips). The student’s parent/guardian must complete and submit the form to the school health office prior to departure of the trip. Medication supply should coincide with the number of doses needed for the duration of the trip and must be dropped off to the school health office by a parent or other responsible adult.

Per District 158 Board Policy: NO STUDENT, regardless of age, may carry or self-administer medications other than those necessary for life-threatening conditions.

Please see your school nurse regarding any questions.

Activity or Field Trip Medication Instruction Form 7.270 F6