Burgettstown area elementary center burgettstown Area School District 100 Bavington Road, Burgettstown, pa 15021



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BURGETTSTOWN AREA ELEMENTARY CENTER

Burgettstown Area School District

100 Bavington Road, Burgettstown, PA 15021

Admin: (724) 947-8136 Elem: (724) 947-8150

Admin Fax: (724) 947-8143 HS Fax: (724) 947-3325
Deborah M. Jackson Melissa M. Mankey Superintendent Elementary Principal
Burgettstown Area School District

Field Trip Medication Form



Dear Parent/Guardian:
Sometimes medications are required while your son/daughter is attending a field trip. These medications may be of the daily oral, injection, or emergency type.
According to current law, the school nurse may not package medications for use on field trips and would not be present to administer them. Therefore, it will be necessary for the parent/guardian to attend the field trip to dispense the medication. If the parent is unable to attend, they may send a representative to participate in the field trip to administer the medication.
If the prescription is to be given three times a day, the medication should be given before coming to school. If the medication is a new prescription, the parent or designee needs to attend the trip to dispense the medication, due to the possibility of adverse reactions.
Parents of students who have a history of being administered daily oral medication, may provide the teacher with a pharmacist-labeled prescription bottle containing one day’s dosage for use on the field trip. The teacher supervising the field trip will carry the medication on the field trip. The medication will be given to the student. The medication will then be self-administered by the student. The teacher shall not be liable for any injury occurring to the student as a result of the above.
Please provide the following information and return this form to the classroom teacher at least two (2) days before the field trip.
Student:_______________________________________ Grade:_________ Date:___________________
Medication/Dosage:______________________________________________________________­­­­______
If there are any side effects, please note:____________________________________________________
Name and relation of person attending to administer medication:_________________________________
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Parent/Guardian Signature:________________________________________________________
Daytime Telephone:_____________________________________________________________
Name of Emergency Contact:______________________________________________________
Emergency Telephone Number:____________________________________________________

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