Self-Administration Medication Authorization Form 

• Emergency medications such as Epi-pen, Inhalers or Glucagon.

• Students may not possess or administer a controlled substance under any circumstances.

• Any misuse of medication by a student, including selling or giving away the medication, violates RCS district policy that will result in revocation of self-administration privileges and may result in a referral to law enforcement officials. 

• Nothing ingested either in liquid or pill form can be self carried. These medications must be kept in the office and distributed by school staff per Michigan law. 
  
  

Consent Form for Self-Administration