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Address:
231 N. Church Street
Rocky Mount, NC  27804
Map It
252-442-1134
866-214-8307, toll free fax
office@goodshepherdrmt.org
 
 
Telephone:
252-442-1134
Stephanie Allen x226
Louise Anderson x230
Sheryll Barnes X221
Virginia Turner  X223
Lawrence Goering X224
Scott White X222
Jackie Wilkins x227
Parish Kitchen X232
Parlor X233
 
Day School:
252-442-1092
dschool@goodshepherdrmt.org
 
Permission to Administer Medication (short form)
Permission to Administer Medication
 
Child’s Name
 
Name of Medication
 
Refrigerate
 
Dosage
 
Times to be given
 
Dates to be given
 
Parent’s Signature
 
Date
 
 
 
Monday
Tuesday
Wednesday
Thursday
Friday
Date
 
 
 
 
 
Time
 
 
 
 
 
Given by
 
 
 
 
 
Date
 
 
 
 
 
Time
 
 
 
 
 
Given by
 
 
 
 
 
Last Published: April 18, 2007 8:28 AM
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