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Goessel USD 411

District Office


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Medication Permission Forms

If you would like medication to be administered to your child during the school day, a permission form signed by the parent/guardian must be on file. The permission form for prescription medications must also be signed by the prescribing provider.

All medications administered to students must be provided to the school in the original container.

Please print and complete page one of the appropriate form and return it to the front office.

We do request that the first ever dose of a medication be given at home, so that the student can be monitored for adverse effects.


Prescription Medication Permission Form

Over The Counter Medication Permission Form