Denver South High School

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Student Medication Forms

In compliance with School District Medication Policy and Procedure, which requires as a condition to its agreement to administer any medication, that the medicine has been prescribed by a PCP or dentist and that it has been furnished by the parent/guardian(s) of the student with the original pharmacy container label stating the child’s name, name of the medication, the dosage, the route, the number of dosages per day or time(s)  and the date when the medication is to be discontinued (if applicable).  This applies to all medications including over the counter. It is understood that the medication is given solely at the request of and as an accommodation to the undersigned parent/guardian(s). The undersigned parent/guardian(s) hereby agree(s) to release the Denver Public Schools and its school staffs from any and all claim(s) which they now have or may hereafter have arising out of the administration of, or failure to administer, the medication to the student. At no time will any school staff(s) recommend or require the student be prescribed psychotropic medication(s) to attend school.

Medication Treatment Release Agreement – English 18-19

Medication Treatment Release Agreement Spanish 18-19