Dear Parent/Guardian,
You are receiving a packet of information for medical consents for the 8th grade trip to Washington, DC. Please read all the information carefully and fill out the forms as completely as possible. Remember, your student will be with chaperones that do not know his/her history or special needs. All rules for medications given at school or on school property are in affect for a school-sponsored trip.
The forms in this packet are color coded to help you plan the trip for your student. Please bring this packet to the parent meeting on March 3rd. Everyone is expected to turn in a completed YELLOW Medical History/Emergency Authorization Form and GREEN Stock Medication Form at the parent meeting. Please do not discard the BLUE or PURPLE forms; you may need them prior to the trip.
§ The Yellow Medical History/Emergency Authorization Form- This form is required for your student to receive any emergency medical care needed while on the trip. This form also provides us with your contact numbers and vital medical information on your student. Please fill this out both sides of the form. We also request a Xeroxed copy of your insurance card be attached to this form. All are required to return this completed form.
§ The Green Stock Medication Form- We will be providing some basic stock medications for students during the trip. Read through the medications, check “yes,” and initial next to the medications that you would like available to your child. If you do not want your child to have a medication, please check “no” and initial. If you do not give us permission, your child will not be given the medication unless we call you. If you do not agree with the dosage, write the specific instructions underneath the medication. Please do not give permission for your student to have a medication if they have never had the medication before. This is not the time to experiment with their reaction to a new medication. Everyone must turn this form in even if you do not want your student to have any of the medications, simply check “no” to all the choices. This will inform us that you are aware of the medication available during the trip and are choosing not to have any stock medication given to your child. All are required to return this completed form.
§ The Purple Non-Prescription Form- If a medication is not on our stock medication form, and you feel your student needs to have it available to them during the trip, please fill out a purple sheet for each medication. You must supply us with this medication. We will only supply the medications listed on the green sheet. If you need more than one form, extra forms will be available at the parent meeting or call the clinic, 740-4406, and extra forms will be sent home to you. A parent/guardian signature is required on this form.
§ The Blue Prescription Form-This form must be filled out for each prescription medication. This form needs to be filled out by your physician and signed by the parent. Even though you have the prescription bottle, we need to have the permission and instructions on the form from your doctor for this specific time period. Keep this form in case there are last minute medications (i.e. antibiotics) that your student may need.
Frequently asked questions:
· Can my student carry his or her own medications? No. Just like at school, students are not permitted to carry medication.
· Are there any exceptions to this rule? Yes. Students are permitted to carry emergency medications; but they must have a form filled out by their physician to do this. Students may and should carry Epi-pens, inhalers, and benadryl needed for life-threatening medical conditions. Diabetics may carry insulin and testing equipment as well. Finally, if a student uses a topical cream/ointment such as acne medication, he/she may self administer this if a medication form is completed and turned in for the trip.
· Can I just list all the medications on one form instead of filling out multiple forms? No. Each medication must be on its own form. This prevents mistakes.
· Can I send medication in a smaller container to save space? No. Each medication must be in its original container labeled with the student’s name, the medication, and the dosage. If a medication is not in its original container it will not be dispensed on the trip. We encourage you to only send the amount of medication needed for the trip plus 1 or 2 extra. You may want to ask your physician to write a prescription to cover the time of the trip and not send your entire supply.
· If my student has a form on file for an epi-pen, inhaler, or any other medication, do I need to have another filled out for the trip? No. If the form was filled out during this school year and there has not been any change from this original order, a new form is not necessary. A copy of the form will be taken on the trip, but please send us a note to remind us to do this. We want to make this convenient, but we don’t want to forget to copy a medication form either.
· If my student has not used an inhaler for a while, should I still send it with him? YES! The environment and allergens will be different in Washington, DC and better to have a rescue inhaler just in case. Please check the expiration dates on the inhaler before the trip.
Any medication that your child needs while in Washinton, DC should be dropped off at the high school clinic no later than March 7th by a parent or adult. Students are not permitted to carry the medication. I encourage you to bring medication and forms to the parent meeting on Monday, March 3rd. Medications will not be accepted on Monday March 31st unless arrangements have been made with Joan Castelucci. Remember it needs to be in the original container and if there are multiple medications, put the containers in one large Ziploc bag with his/her name on it. Joan Castelucci will be there to take the forms and medications as well as answer any questions you may have. Please mark what time of day the medication should be given on the form. This saves time and phone calls when we are setting up our medication schedule.
We would like to stress that all information given to us is confidential. . Joan Castelucci will be the RN traveling with the group to Washington, DC. If you need to contact her, she can be reached at: 740-4406 or . If there are medical concerns or privacy issues please contact Lisa Witzke at 740-4706 or email her at
If you have any questions or concerns, PLEASE contact Joan or Lisa. Don’t wait until the morning the students are leaving to address a problem. Any help we may be able to provide may not be possible at the last minute. Think ahead and this will be healthy and memorable trip.
Yours in health,
Lisa Witzke RN Joan Castelucci RN
Health Care Coordinator Middle School Clinic
Brecksville-Broadview Heights City Schools