Form

Hillcrest Christian School DBA Heritage Christian School understands the seriousness of certain medical conditions and a need for immediate medication. Students will be allowed to keep medication on their person under the following conditions:

• A REQUEST FOR MEDICATION TO BE TAKEN DURING SCHOOL HOURS form must be completed by a licensed physician and kept on file in the Health Office.
• The medication must be kept in the original prescription box with the name of the student and all information listed.
• Additional duplicate medications and supplies will be kept in the Health Office.
• The medication is strictly for the students' own use and will not be shared with or provided to any other student.
• This is a revocable privilege.
• The school will not assist or participate in the administration of the medication, unless student comes to the Health Office.
• If the student needs to self administers the medication, they MUST report to the Health Office between 8am-4pm. If the event occurs outside of the Health Office hours, the student must report to a coach or to student supervision in room 108.

This is to certify that I have read the above and agree to follow the above conditions. Further, I hereby agree to hold harmless and indemnify the school, school board, administration, teachers and staff from any claims, damages, or expenses arising out of any injury or death of any person, or damage to property which may result from administration of the medication or from any harmful effects of same.