OMFS Medication Direction for Educators - Oro-Medonte Forest School

If you have selected yes on the OMFS Registration and Health Information Form to an allergy, asthma, or your child requires medication for another condition, please fill out this form.

If you have more than one child with an allergy, asthma, or other condition requiring medication, we require a separate form for each child.

Please note that OMFS Educators cannot administer medication to your child without the completion of this form.

Please also note that any changes to this form require that you complete the form again so we may update our records.

OMFS Educators cannot administer medication that has not been prescribed by your child’s physician.

OMFS Medication Form

Please fill this out if your child is required to take medication at Forest School due to an allergy, or other condition.

1. Child's Full Name(Required)

2. Parent/Guardian's Full Name(Required)

3. Parent/Guardian's preferred contact information(Required)

4. Name of medication:(Required)

5. Was this medication prescribed by your child's physician?(Required)

Please also list their name and phone number here. Note: OMFS can only administer medication that has been prescribed by a child's physician.

6. For what condition is this medication required?(Required)

Please fill out the section below which pertains to this question. If more than one applies, please fill out each applicable section.

A) Allergy

B) Asthma

C) Other

A) Allergy Information

Please fill out this section is you selected "allergy" in question 6 above:

Allergen(s):

Please describe the typical allergic symptoms that would lead to administering the medication:

Does your child use an epi pen?

For all life threatening allergies (requiring an epi-pen), children will be required to self carry their medication at all times.

Does your child use Benadryl?

If Benadryl is used prior to the administration of an epipen, please describe the sequence of events at the bottom of this page.

Does your child require assistance administering an epi-pen?

Please describe how you would like us to assist your child.

B) Asthma

Please fill out this section if you selected "asthma" in question 6 above:

Does your child require an inhaler?

For children with infrequent flare ups of asthmatic conditions, inhalers may be kept in their backpacks, for all others, they must be self carried.

Does your child require assistance administering their inhaler?

Please describe the typical symptoms that would lead to administering the medication:

C) Other

Please fill out this section if you selected "other" in question 6 above:

For which condition is this medication required?

Please indicate the dose, frequency, and method of administration for this medication here:

Information for Educators:

Please describe here, in detail, what steps you would like our Educator's to take when administering this medication to your child.(Required)

Your signature here indicates that you consent to OMFS Educators administering the above medication to your child based on the directions you indicated above:

OMFS Medication Form

A) Allergy Information

B) Asthma

C) Other

Information for Educators:

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