Student Handbook

Medical Form

Students Name : _____________________________________________

Last Name, First Name
PERMISSION TO ADMINISTER MEDICATION AT RTCA

My child(ren) may be given Tylenol, Advil, Motrin, Pepto-Bismol or cough drops by the school administrator. I understand that any other medications must be kept in the administration office and will require a note and dosage instructions signed by the parent.

Please list any medications each child takes on a daily basis:

As the parent(s)or legal guardian of the student(s) listed above, I/we hereby grant to the Headmaster (or whomever he/she may designate) of Robert Toombs Christian Academy, the authority to sign authorization for medical treatment of the above named student(s). This authority is granted only under the following three (3) conditions: (1) the injury was incurred during school hours, (2) the injury was incurred while participating in athletic games representing Robert Toombs Christian Academy , (3) the parent or legal guardian is not available to sign authorization at the time of injury. Authorization covers any emergency treatment prescribed by the licensed physician assessing the injury (including admission as inpatient).