Consent Form For Administering Prescription Medicine

Please make sure to list all the students attending St. Henry District High School

Parent/Guardian Information

Parent/Guardian Name(Required)

Student(s) Information

Student Name Grade Level Medication Information Actions
     
Clear Signature

Admissions Department

Mrs. Toni Lehan
tlehan@shdhs.org
859-525-0255 x2826

Technology Department

Jorge Carbwood
jcarbwood@shdhs.org
859-525-0255 x2820