Please note: A new form should be used for each medication, whether prescription or non-prescription. Medication must be in original container with the child’s name visible and clearly written on packaging. Please place all medications in a zip lock bag to help secure medicines store dispensing record, and aid person administering medication.
Please include anticipated date and time
I hereby authorize Camp Deer Lake to administer listed medication to my child according to the instructions on the medication label.
To be completed by person administering medication.