Free templateAdministration

Regular Medication Form

A three-page medication form titled “General Medication Administration”: a parent/guardian section covering the medication, dosage, dates and previous use, a sign-off page with times, purpose and instructions, and a staff log for each dose given.

Format: Printable PDF · US Letter
Pages: 3 (parent section, sign-off, staff log)
Best for: Directors · room staff
Updated: Sept 2026

Download free template See what’s inside

No sign-up required. Print it and share it with your team — it’s free for any child care program to use.

What’s inside

Parent details first, then a staff log for every dose

Office use blockName of child and name of medication at the top of page one.
To be completed by Parent/GuardianChild’s name, medication or herbal remedy, expiration date, amount to be given/dosage, start and finish dates, and when the medication was prescribed.
Yes/No safety questionsIs it already given at home, has it been used before, were there any negative reactions, is the child’s name on the medication, and is it in the original container.
Instructions and sign-offExact times to be given, purpose for the medication, how to administer it, the parent/guardian’s name, signature and date, and initials from the director/designate and lead teacher.
Part 2: staff administration logDate, medication, dosage, time and staff signature, completed each time the medication is given.

How to use it

Four steps to put it to work this week

1
Have the family complete the parent sectionOriginal container, matching label, and the form filled in and signed before you accept the medication.
2
Check the label against the formName, dose and timing must match exactly. If they do not, call the family before giving anything.
3
Log every dose in Part 2Date, medication, dosage, time and staff signature, written at the time the dose is given.
4
Return or dispose at the finish dateNote it on the form and have the family sign for returned medication.

Tips from operators

What centers that use this well do differently

Learned the hard way across 3,000 child care spaces — and from the directors and educators who join our Lunch & Learns and Learning Labs.

Set a reminder, not a hope

Midday doses get missed in busy rooms. A timed alert on the room tablet is the single most effective fix.

Keep emergency meds visible and reachable

EpiPens and inhalers should be where the child is — with the outing bag, not locked in the office.

Audit the log monthly

A five-minute check for missing signatures each month is far better than finding them during an inspection.

Do it digitally in ChildFriendly Pro

Custom checklists and forms, time-stamped and filed for inspection

Build any checklist or form once in ChildFriendly Pro, assign it to a room or role, and every completion is time-stamped, signed and filed in your inspection binder — ready for licensing or public health.