Prescription Medication Form
Non-prescription Medication Permission Form
High School Non-prescription Medication Permission Form


Because of the increasing number of medications being brought to school, we would like to review the School District of Shiocton’s medication policy with you.
Medications brought to the school office:
If you wish to have school personnel administer medication to your son/daughter, YOU MUST BRING IT in the original or pharmacy labeled container, properly marked with the name of the student, name of the medication, dosage, and time to be given.
**It is the parent’s responsibility to provide all prescription/non-prescription medication or treatment to the school.
Administration of Medication Consent Form:
This form must accompany both prescription and non-prescription medication. The district medical advisor has approved the following guidelines;
  • Both Parent/guardian and physician must sign the medication consent for administration of any prescription medication during the school day.
  • For non-prescription medication to be administered during the school day, only the parent/guardian signature is required.
  • Only a limited supply of medication should be brought to school at any one time.
  • Parent/guardian is responsible for personally delivering controlled substances to school office personnel/school nurse.
  • Controlled substances should be counted and the number of pills documented on the medication form each time medication is brought into the school office. 
School personnel will administer no medication unless this policy is followed. If a child brings medication to school without the appropriately signed form or non-matching prescription bottle, the school will notify the parent or guardian that the medication will not be given until the necessary signatures or labels are provided. In the interim, the parent will be invited to administer the medication to the child at school.
Medications kept by the students:
According to school district policy, medications (both prescription and non-prescription) are generally not kept by students during the school day. However, special health concerns may warrant a change in procedure (i.e., inhalers). At the high school level, grades 9-12, responsible students may also have medication in their possession if the following criteria are adhered to:
  • A properly completed and signed medication form is on file in the school health office, and
  • The student has consulted personally with the high school nurse.
  • Students may NOT dispense any (prescription or non-prescription) medication to another student.
  • Students may NOT self-administer any medication without authorization according to school policy. 
Information to consider:
  • When you know that your child will be on medication, discuss the hours of administration with your physician. It may be possible to regulate the dosage so that the medication could be done while your child is at home.
  • Natural products (of any kind) will not be given during the school day unless approved by the FDA and meet the criteria as outlined in school policy guidelines.
  • School District of Shiocton
  • N5650 Broad Street PO Box 68, Shiocton, WI 54170
  • Phone: (920) 986 - 3351 | Fax: (920) 986 - 3291
  • Email