ContractJanuary 29th, 2022
FiledJanuary 29th, 2022MONTGOMERY COUNTY PUBLIC SCHOOLS MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESRockville, Maryland 20850 AUTHORIZATION TO ADMINISTER PRESCRIBED MEDICATIONRelease and Indemnification Agreement PART I—TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (MCDHHS) personnel to administer prescribed medication as directed by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required.Student: Birthdate: / / School: Prescription: # Renewal # New If new, the first full d
ContractNovember 30th, 2021
FiledNovember 30th, 2021MONTGOMERY COUNTY PUBLIC SCHOOLS MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESRockville, Maryland 20850 AUTHORIZATION TO ADMINISTER PRESCRIBED MEDICATIONRelease and Indemnification Agreement PART I—TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (MCDHHS) personnel to administer prescribed medication as directed by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required.Student: Birthdate: / / School: Prescription: # Renewal # New If new, the first full d
ContractApril 27th, 2001
FiledApril 27th, 2001MONTGOMERY COUNTY PUBLIC SCHOOLS MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESRockville, Maryland 20850 AUTHORIZATION TO ADMINISTER PRESCRIBED MEDICATIONRelease and Indemnification Agreement PART I—TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (MCDHHS) personnel to administer prescribed medication as directed by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required.Student: Birthdate: / / School: Prescription: □ Renewal □ New If new, the first full d
ContractApril 27th, 2001
FiledApril 27th, 2001MONTGOMERY COUNTY PUBLIC SCHOOLS MONTGOMERY COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICESRockville, Maryland 20850 AUTHORIZATION TO ADMINISTER PRESCRIBED MEDICATIONRelease and Indemnification Agreement PART I—TO BE COMPLETED BY THE PARENT/GUARDIAN I hereby request and authorize Montgomery County Public Schools (MCPS) and Montgomery County Department of Health and Human Services (MCDHHS) personnel to administer prescribed medication as directed by the physician (Part II below). I agree to release, indemnify, and hold harmless MCPS and MCDHHS and any of their officers, staff members, or agents from lawsuit, claim, demand, or action against them for administering prescribed medication to this student, provided MCPS and MCDHHS staff are following the physician’s order as written in Part II below. I have read the procedures outlined on the back of this form and assume the responsibilities as required.Student: Birthdate: / / School: Prescription: □ Renewal □ New If new, the first full d