PLEASE SIGN AND RETURN THE FOLLOWING TO YOUR CHILD'S

TEACHER! EVERY STUDENT NEEDS TO HAVE THIS FORM ON FILE!!

_____________________________                                          ___________________________

             STUDENT'S NAME                                                                  CLASSROOM TEACHER

        Hillsboro School Medication Policy in compliance with "Tennessee State Law"

        is as follows:

• Parents must bring mediation to the Nurse's Office.

• Parents must sign in before going to Nurse's Office.

• Parents must have a "Medication Authorization" form with both physician and parents signatures. These forms may be obtained from the School Nurse.

• NO MEDICATION, INCLUDING OVER THE COUNTER MEDICATIONS MAY BE BROUGHT TO SCHOOL BY STUDENTS!!!!     

       We have read and understand the Hillsboro School Medication Policy.

_______________________________                                        ______________________

            PARENT'S SIGNATURE                                                                         DATE

*******Contact Mrs. Jan Henley R.N., if you have any questions.