EMERGENCY MEDICATION FORM

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DEVICE
CHILD’S NAME:
CAN THIS MEDICATION BE REPEATED?
I, the undersigned parent/guardian authorize school staff to administer the medication named above and understand that my child’s emergency medication will be kept in the child’s classroom and will NOT be carried by staff on field trips. I give permission for administration of the above named medication to my child in an event that staff determine using their judgement. I understand that I am expected to leave a current prescription at Gateway for the duration of the school year. I understand it is recommended my child wear an Emergency Medical Bracelet while attending school. It is understood that it is the parent/guardian’s responsibility to ensure the medication is current without expiration. I also hereby acknowledge that these services are solely for the convenience of the recipient, and that such service will be provided by a person who is not a healthcare professional. I agree to indemnify, defend, and hold harmless Gateway School for Young Children LLC, its teachers, officers, employees, and staff from any and all claims, damages, costs, charges, expenses, and suits arising out of, or resulting from, the giving, or failure of giving medication as provided above. I release Gateway School for Young Children LLC or any liability, costs, and expenses (including attorney’s fees) arising out of or in connection with any action, claim, or other legal proceeding brought against you by the parent/guardian who has not signed this agreement.