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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
Tom Parker X221
Scott White X222
Virginia Turner  X223
Lawrence Goering X224
Juliana Lindenberg X226
Jackie Wilkins x227
Louise Anderson x230
Parish Kitchen X232
Parlor X233
Paulette Pridgen X234
 
E-Mail:
swhite
jlindenberg
ppridgen
tparker
vturner
jwilkins
lgoering
landerson
@goodshepherdrmt.org
 
Day School:
252-442-1092
dschool@goodshepherdrmt.org
 
Permission to Administer Medication (long form)
Permission to Administer Medication
 
Child’s Name
 
 
Name of Medication
 
 
 
 
 
 
Dosage
 
 
Refrigerate :
 please circle     Yes    or    No
 
 
 
 
 
Times to be given
 
 
 
 
 
 
 
 
 
Dates to be given
 
 
 
 
 
Parent’s Signature
 
Date
 
 
-------------------------------------------------------------------------To be filled out by Staff --------------------------------------------------------------------
Monday
Tuesday
Wednesday
Thursday
Friday
 
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Last Published: April 18, 2007 8:29 AM
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