Medication Forms

Over-the-Counter (Non-Prescription) medication or products:

• pain reliever, topical lotion, ointment, throat lozenges, eye drops, vitamins, supplements etc. or

• Any prescription medication

• For Inhalers, Epinephrine or Benadryl see boxes below

1. Parent-Physician Medication Release signed by parents and Medical Doctor

2.    All medications must be in the original container.

3.    Prescription medications require the current prescription label.

4.    If doctor signs non-Rocklin Academy form (ex: Kaiser form), then parents still need to sign the Rocklin Academy Parent-Physician medication release

5. General Medications cannot be carried by a student. Only rescue meds can be carried by a student.

● Inhaler / Asthma Medication*

1.      Asthma Action Plan signed by parents and Medical Doctor

2.     If doctor signs non-Rocklin Academy form (ex: Kaiser form), then parents still need to sign the Rocklin Academy Parent-Physician medication release.

 3.       Self Carry Medical Release

* If student self carries, then it must be indicated by the MD on the Asthma Action Plan and student and parent need to complete self-carry contract.

• ·     Epinephrine / Benadryl

1.      Parent-Physician Medication Release signed by parents

3.      Allergy History Form signed by parents

For Field Trips:

All of the above required documentation must be turned into the school office no less than two weeks prior to the field trip.

Rescue Meds that can be carried by a student: 

·    The paperwork is signed and complete

·   Prescription label is included

·    Medication is in the original container

·    Medication is current (not expired)

·    Delivered by a parent, guardian or designated adult

·    Medication matches doctor’s orders