Student Medication Form

“Medication” is any substance a person takes to maintain and/or improve his or her health. This includes vitamins &
natural remedies. Provide enough of each medication to last the entire time the student will be at St. John’s College.
The following guidelines pertain to administering medications:

1.) Written parent/guardian permission is required to administer medication. 2.) All medication shall be administered only as specified on the prescription label or the manufactures label, 3.) All medication will be recorded on the Medication Release Log. 4.) All medications must be in the original Rx containers, labeled with the student’s full name, instructions for administration, date prescription was filled, and expiration date. 5.) All medication is to be kept in a locked medication box stored in the Health Center, inaccessible to any 6.) Parents/Guardians are responsible for picking up their child’s prescription vials after the closing ceremony. All medications will be stored and dispensed from the SJC Health Center. The student will be responsible to report
to the Health Center to receive their medication at the times specified in the Medication Release Log.
The only
medications that will be exempt from this policy are emergency medications (i.e. asthma and allergy medications). If
you have any questions, please contact Nancy Calabrese, Director of Student Health Services, or Lynda Turner,
Assistant Director of Student Health Services, at 410-626-
The following non-prescription medications may be stocked in the College Health Center or in the RA rooms
and are used on an as needed basis to manage illness and injury.

Cross out those the student should not be given:

For Office Use Only
Student Name:__________________________________________ Annapolis: Session I______ Session II______ Student Medication Form


Please check the appropriate box:
 This student will not take any daily medications while attending St. John’s  This student will take the following daily medication(s) while at St. John’s:  Lunch  Dinner  Bedtime  Other time:_____  Dinner  Bedtime  Other time: _____  Lunch  Dinner  Bedtime  Other time: _____ I, the undersigned, the parent/guardian of ________________________________, request that the medication documented above be administered to my child. I give permission for staff of the St. John’s College Student Health Center and any other authorized person to administer the medication listed above to my child. I understand that when medication is given according to instructions, I will not hold my provider liable for any reactions or complications that may follow as a result of my child receiving this medication. ____________________________________________ ____________________________________________ For Office Use Only
Student Name:__________________________________________ Annapolis: Session I______ Session II______


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