1545 E 8425 S Sandy, UT 84093

Ranked No.2 In Utah

Medication Release Form

Peruvian Park Policy


Parent must furnish the school with a completed School Medication Authorization Form prior to any medications being administered by school personnel. • The medication must be delivered to the school by the parent in the original container, labeled with the child’s name, medication, time, dosage, and healthcare provider’s name. • All medication must be delivered to the school by an adult and picked up by an adult within two (2) weeks of last dose given. • If there is a change in the medication or medication dosage, a new School Medication Authorization Form must be completed before school personnel can administer the new medication or new medication dose.

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