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Get Santa Rosa County School Board Medication Form

This form complies with applicable Florida Statute and will become the property of the school for filing purposes. (Continued on reverse side) Section - VIII 5 REGISTRY OF MEDICATION FORM (Florida Statute 232.46) Date Medication # Meds Counted Parent/Guardian Signature Staff Signature FIELD TRIP SIGN OUT Date Medication # Signed Out # Returned Teacher/Staff Signature School Health Clinic Staff Signature *By my signature, I acknowledge that I have received training on Medication.

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