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Medication Authorization Form

Woodbridge Township Board of Education School District Policy:

In general, the Board may permit the administration of medication to a student provided that the following conditions are met:

1. The parent/guardian provides to the school written authorization for such administration;

2. The parent/guardian provides to the school the written order of the prescribing physician which shall include the medication name, dosage, time, and route of administration; and

3. The parent/guardian brings the medication to the school nurse in a current prescription container, appropriately labeled by the student’s physician or the pharmacist. In the event of an “over the counter” medication, it must be brought to school in the original packaging with the student’s full name. Medications shall be securely stored and kept in the original labeled container.

Please print the following form and bring it to your child's healthcare provider. Have the form complete, sign it, and bring the form with the medication to the school nurse.

Medication Authorization Form