Medication Form | Castle Hill Funhouse

Administration of Medication Form

To give Funhouse permission to administer medication while your child is in care, please complete the following form.

Child's Full Name

Name of Medication

Method of Administering Medication

Dosage of Medication

Time of dosage to be given

03:00 PM

Please note that the Funhouse staff must see the prescription packaging to verify the medication name and change requirement

Date to start medication administration (DD/MM/YY)

Date to finish medication administraion (DD/MM/YY)

Reason for administering medication and other relevant information.

When was medication last administered - please provide time and date.

Medical Practitioner Authorising Medication

Only prescribed medication with the correct labelling (child's name and dosage) will be administered at Castle Hill Funhouse.

Each family is responsible for informing Castle Hill Funhouse in writing if there are any changes to medication administration.

Tick box to acknowledge/accept the statements above

Comments (if required)

Parent/Guardian Full Name

Parent/Guardian Signature

Today's Date