DUNLAP COMMUNITY UNIT SCHOOL DISTRICT 323 7:270
Page 1 of 1
Students should not take medication during school hours or during school-related activities unless it is necessary for a student’s health and well-being. When a student’s licensed health care provider and parent(s)/guardian(s) believe that it is necessary for the student to take a medication during school hours or school-related activities, the parent/guardian must request that the school dispense the medication to the child and otherwise follow the District's procedures on dispensing medication.
No School District employee shall administer to any student, or supervise a student’s self-administration of, any prescription or non-prescription medication until a completed and signed “School Medication Authorization Form” is submitted by the student’s parent/guardian. No student shall possess or consume any prescription or non-prescription medication on school grounds or at a school-related function other than as provided for in this policy and its implementing procedures.
A student may possess an epinephrine auto-injector (EpiPen®) and/or medication prescribed for asthma for immediate use at the student’s discretion, provided the student’s parent/guardian has completed and signed a “School Medication Authorization Form.” The School District shall incur no liability, except for willful and wanton conduct, as a result of any injury arising from a student’s self-administration of medication or epinephrine auto-injector or the storage of any medication by school personnel. A student’s parent/guardian must indemnify and hold harmless the School District and its employees and agents, against any claims, except a claim based on willful and wanton conduct, arising out of a student’s self-administration of an epinephrine auto-injector and/or medication, or the storage of any medication by school personnel.
Nothing in this policy shall prohibit any school employee from providing emergency assistance to students, including administering medication.
The Building Principal shall include this policy in the Student Handbook and shall provide a copy to the parent(s)/guardian(s) of students.
LEGAL REF.: 105 ILCS 5/10-20.14b, 5/10-22.21b, and 5/22-30.
ADOPTED: April 10, 2002
REVISED: November 8, 2006
DUNLAP COMMUNITY UNIT SCHOOL DISTRICT #323
Physician and Parent Permission to Administer Medication
I hereby give permission to personnel in the Dunlap Community Unit District to
administer medication to ___________________________________________during
(Student’s Name)
the school day or during school sponsored activities as described below.
I understand that personnel being requested to administer medication ARE NOT trained medical personnel and that they have little, if any, knowledge of medical procedures.
____________________________________ ____________________________________
Attending Physician’s Signature Parent / Guardian’s Signature
____________________________________ ____________________________________
Address Address
____________________________________ ____________________________________
Physician’s Phone Number Date Work Phone Home Phone Date
Type of Medication________________________________ Dosage____________________
Time to be given_______________________________________________________________
Effective Date(s): From _____________________________to_________________________
Possible Side Affects from this medication: _______________________________________
______________________________________________________________________________
Protocol / Procedures /Actions to be taken in case of a reaction to this medication: ____
______________________________________________________________________________
______________________________________________________________________________
Note: 1. Medication must be brought by the parent / guardian to the school office in
containers properly labeled by the pharmacy.
My signature below absolves the district and its personnel of any and all responsibility related to the administering of the above named medication and/or the results of administering said medication.
____________________________________________________________
Parent / Guardian’s Signature Date
District 323 Form 725.02-A