Small Town Values; Big World Opportunities | (920) 487-7001 | 1715 Division St. Algoma, WI 54201

Medical Forms

Administration of any medication to students is governed by Wisconsin Statute 118.29

General Information:

  • Written parent/guardian permission is required prior to administration of medication (see below forms)
  • Medication will only be accepted at school in original containers or labeled pharmacy bottles.
  • Medication must be transported to and from school by an adult
  • There are certain medications that, with permission, students may carry and self-administer (ex: inhlaers, epinephrine, insulin). Contact the nursing office to make arrangements. 487-7001 ext. 1110

Medication Consent Form

  • Please fill out this form for Prescription, Over-the-Counter and Asthma Medication turn in to the school office
  • Prescription and/or Asthma Medication will need a provider signature, to assist you, staff can fax the form to the provider for a signature
  • Over-The-Counter, Herbal Supplements and/or Essential Oils will need provider signature if taken in dosage other than recommended therapeutic dose

Directions for parents on how to fill out the Medication Consent Form

  • These directions should guide you if you have questions on how to fill out the form. Otherwise please call the Nursing Office at school 487-7001 ext. 1110