Saint Agnes Catholic Parish of Butler, WI
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Medication Forms

If a child needs medication during the school day, we must have parental permission on file at the school office.  There are different forms for different medications.

Parent/Guardian Medication Consent Form

This form allows the school office to administer over the counter medication that you have sent with your child.  This may include Tylenol, ibuprofen or cough drops, just to name a few.

Prescription Medication Authorization Form

This form allows the school office to administer prescription medication.  This form must be filled out by your physician.

Emergency Medication Form

This form allows a student to carry emergency medication at all times.  This would include an inhaler or epi-pen. This form must be filled out by your physician.

If you have any questions about these forms, please call the school office at (2620 781-4996.

 

Saint Agnes Catholic Parish
12801 West Fairmount Avenue
Butler, WI 53007
Phone: 262-781-9521
Fax: 262-781-3512
stagnesparish@hotmail.com
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