Clinic - Covenant Christian Academy

Student Medication Authorization Forms

As we prepare for this upcoming school year, please consider whether you want to have Clinic staff administer medication (provided by parents to Clinic) to your student during the school day.

Students cannot bring medication to school; parents must deliver any medication to CCA's Clinic staff.

If you wish to deliver a medication to the school Clinic staff, please note the following:

Epi-pens

Please have your student’s physician fill out the form below. (This year, this is the only form we need for epi-pens.):

Allergy Action Plan 22-23

Inhalers

Please have your student’s physician fill out the form below. (This year, this is the only form we need for inhalers):

Asthma Action Plan

All Other Medications

When filling out the Authorization form, the parent's instructions on dosage on an Over the Counter Medication must match the instructions on the actual medication box/container, or a physician must fill out the form as if for a prescribed medication.

An Authorization to Administer Medication form must be filled out for each medication (not Epi-pens or inhalers):

Authorization for Medication Administration 22-23