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Authorization to Self-Administer Medication Form

 Medication Form

By law, college instructors and staff are not permitted to hold or administer any medication of any type. Therefore, you and your child are responsible for keeping and administering perscription and over the counter medication.

If a student carries any medication with him/her during the program you must have the Authorization to Self-Medicate Form (Medication Form) completed by your child's physician.

This form needs to be on file at the Youth Program office prior to the start of class. A separate form must be completed for each medication, prescription, or over-the-counter drug.

Should a medical emergency occur, trained personnel from the Campus Security Office will be available to render aid.

EpiPen

  EpiPen® or EpiPenJr® Medication Form

If your child has an allegy and carries an EpiPen® or EpiPenJr® with him/her as a safety precaution, you must have the Authorization to Self-Medicate Form (Medication Form) completed by your child's physician.

This form needs to be on file at the Youth Program office prior to the start of class.

If your child is young and unable to self-administer an EpiPen®, the parent or guardian must fill out the EpiPen® Administration Permission Form.

Kids at College 

Gifted and Talented Programs GT Form

Classes designated Gifted and Talented (GT) must have  the GT Form signed by your child's school principal or designee. This completed form must be on file prior to the start of the class to complete the registration.

   
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  • Montgomery College WD & CE
  • 51 Mannakee Street
  • Rockville, MD 20850

Montgomery College

Montgomery County, MD

240-567-5000

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