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Yeshivas Lev Simcha Medication Authorization form:

This form is to provide medical and parental authorization for medication to be provided during Yeshiva hours.  This is the parent/legal guardian portion of the authorization process and must  be  completed  entirely,  signed,  and returned to the school before the medication may be administered.  Over the counter medication such as Tylenol, cough syrup, Benadryl, Advil, and nutritional supplements also need this form filled out completely including the physician  section. 

 

 

 

The following section is to be completed by the parent or legal guardian: 

I hereby grant permission to the principal (or his/her designee) of my son's Yeshiva to administer the prescribed medication to my son listed in the physician authorization form  while in Yeshiva and  away from Yeshiva while participating in official Yeshiva activities (F.S. 1006.062). It is my responsibility to notify the Yeshiva if and when these orders change.  I understand the law provides that there shall be no liability for civil damages as a result of the administration of such medication where the person administering such medication acts as an ordinary reasonably prudent person would under the same or similar circumstances. I understand the Yeshiva will not be responsible for monitoring a student’s self -medication. 

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Parent's Medication Authorization Form

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Yeshiva Office

info@ylsboca.org
Tel: (561) 206-4248‬

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