Follow the steps to complete the medication request form.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by providing the student’s name in the designated fields, including the last name, first name, and middle initial. Ensure that these details are printed clearly.
3. Input the student's date of birth, grade, school, and student ID number in their respective fields. These details are crucial for identifying your child correctly.
4. Specify the name of the teacher in the section labeled for teacher information. This helps to ensure proper communication regarding the medication.
5. Complete the statement requesting medication administration by authorized school personnel. Acknowledge your responsibility to provide and replenish the medication, ensuring it is in the original container with the label intact.
6. Sign and print your name as the parent or guardian, along with the date and your contact phone number, ensuring your signature matches your printed name.
7. If applicable, have a licensed healthcare provider fill out their section of the form, including the medication name, reason for administration, dosage, and any special instructions or side effects.
8. Once all sections are complete, double-check for any missing information. Save any changes made to the form before proceeding.
9. Download, print, or share the completed form as required. Ensure you keep a copy for your records.

Complete the VA Chesterfield County Public Schools AAA-1075 online today to ensure your child's medication needs are met.