Field Trip Consent Form - Pleasant Valley High School Bands

Students (grades K-12) requiring administration of emergency medications on a field trip will
be allowed to carry and self administer the medication if the following criteria have been met:
1) The parent/guardian has completed the section of the field trip consent form that
addresses the administration of emergency medications.
2) The student has on file in the nurse’s office authorization for administration of the
medication that meets all the criteria addressed in Part B of the USE OF
MEDICATIONS – refer to opening day packet.
3) The medication is currently located in a secure place within the school for use by
the student.
4) The student will be responsible, on the day of the field trip, to obtain his/her
medication from the school location to carry on the field trip. The nurse is
responsible for verifying that the medication is properly labeled, verifying the
student is able to state when the medication is to be taken and notifying the teacher
that the student is carrying the medication.
5) The student is to return the medication to the nurse upon returning to the school
unless they have brought medication from home for the field trip. If the student
has brought the medication from home the student must still report to the
nurse on the day of the trip (if the trip is within school hours) to verify the
correct medication has been sent and review information covered in step 4
with the student.
Parents of students (grades K-7) who receive routine medication during school hours
• may choose to have the child not receive his/her medication on the day of the
field trip;
• may choose to accompany the student on the field trip and the parent may
administer the medication; OR
• the parent may make arrangements for another adult to accompany the
student on the field trip to administer the medication.