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Please review and sign below indicating the medication permissions you give for your student while on
overnight travel with San Antonio ISD.
Students are not allowed to carry any medications on their person, including non-prescription medications,
unless written permission has been provided by a physician and parent for certain medications (see below).
Medications not permitted to be self-carried will be maintained and dispensed by District staff.
MEDICATIONS: All medications must be brought by the students parent/guardian to the designated District
employee responsible for the administration of the students medication(s). Medications must be in the original
container or prescription bottle with proper labeling.
Medication #1:
Name Dose Time(s) Route
Medication #2:
Name Dose Time(s) Route
Medication #3:
Name Dose Time(s) Route
Medication #4:
Name Dose Time(s) Route
Parent/guardian authorization must be indicated for each medication listed below. No signature will be
interpreted as no authorization.
Printed Name
as directed. I understand the procedures for the dispensing of non-prescription, prescription, and emergency
medications while my student is on overnight travel with SAISD.