Hudson School District Nurse Consent

Consent for Nursing Care and Treatment in the School Setting

New Hampshire law requires that parents/legal guardians provide written consent allowing for medical and dental treatment of students in a school setting. This may include, but is not limited to, treatment of illness or injury and basic First Aid. The nursing staff reserves the right to call 911 in the event of a medical emergency. (Hudson School District is not responsible for cost incurred in the event EMS determines transport via ambulance is necessary). Examples of conditions treated in a school setting include, but are not limited to, sprains, strains, fractures, splinters, wounds/lacerations, burns, allergic reactions, asthma attacks, diabetic emergencies, GI illnesses, and headaches.
Student Name Student Name First Last
Student's Current Grade
I authorize the school nursing staff to assist and provide treatment and care to my student as needed.
I agree that I will not hold liable any member of the school staff whose duty is to treat and care for my student.
Parent/Guardian Signature - Nurse Treatment Parent/Guardian Signature - Nurse Treatment First Last
Signature Date - Nurse Treatment Signature Date - Nurse Treatment / MM / DD YYYY
Consent to Administer Over-the-Counter Medication

The school nurse has a limited supply of over-the-counter medication that may be dispensed with written parental permission.
Please check off each medication that you give permission for the nurse to provide:

Please check off each medication that you give permission for the nurse to provide: Acetaminophen Ibuprofen (may contain red dye) Antacids Cough Drops (may contain red dye) None
I give permission for the school nurse, a substitute nurse, or any other member of the school staff designated by the principal (RSA 311.02), to administer the medications that are checked off above.
By signing this form, I agree to hold harmless and indemnify the Hudson School District and any staff member of all losses that my be occasioned as a result of taking this medication, including a severe adverse reaction.
Parent/Guardian Signature - OTC Medication Parent/Guardian Signature - OTC Medication First Last
Signature Date - OTC Medication Signature Date - OTC Medication / MM / DD YYYY

Hudson School District Nurse Consent

Hudson School District Nurse Consent

Consent for Nursing Care and Treatment in the School Setting

Consent to Administer Over-the-Counter Medication