Access Keys:

 
 

Request for Administration of Medication – Information, Consent and Indemnity

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YES, they can self-administer this medication.
 
NO, they cannot self-administer this medication.
 
I consent for staff members in the school to administer/supervise administration of the above mentioned medication to my child (named above), under the circumstances outlined above.

I understand that information about my child’s medical condition and treatment will be shared with school staff, and in the event of an emergency with the GP or other medical personnel.  I also consent to the disclosure of this information to the school’s insurers if required.

This indemnity is made between (the lawful parents are hereinafter called ‘the parents’) of the One Part AND for and on behalf of the Board of Management of Carbury National School situated at The Mall in the County of Sligo (thereinafter called ‘the Board’) of the Other Part.

WHEREAS:      

  1. The parents are respectively the lawful father and mother of named pupil of the above school.
  1. The pupil suffers on an ongoing basis from the condition stated.
  1. The pupil may, while attending said school, require, in emergency circumstances, the administration of medication viz.
  1. The parents have agreed that the said medication may, in emergency circumstances, be administered by the said pupil’s classroom teacher and/or such other member of staff of the said school as may be designated from time to time by the Board.

NOW IT IS HEREBY AGREED by and between parties hereto as follows:

            In consideration of the Board entering into the within Agreement, the parents, as the lawful             father and mother respectively of the said pupil HEREBY AGREE to indemnify and keep              indemnified the board, it’s servants and agents including without prejudice to the generality             the said pupil’s class teacher and/or the Principal of the said school from and against all             claims, both present and future, arising from the administration or failure to administer the             said medicines.

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