{"id":1230,"date":"2021-06-14T14:18:59","date_gmt":"2021-06-14T19:18:59","guid":{"rendered":"https:\/\/andrewsmemorial.org\/camp\/?page_id=1230"},"modified":"2021-06-15T12:55:50","modified_gmt":"2021-06-15T17:55:50","slug":"permission-to-administer-medication","status":"publish","type":"page","link":"https:\/\/andrewsmemorial.org\/camp\/permission-to-administer-medication\/","title":{"rendered":"Permission To Administer Medication"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block\" id=\"wpforms-1225\"><form id=\"wpforms-form-1225\" class=\"wpforms-validate wpforms-form\" data-formid=\"1225\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/camp\/wp-json\/wp\/v2\/pages\/1230\" data-token=\"6a2feee1ba081115b25c6b5701c1ac1d\" data-token-time=\"1777403934\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1225-field_5-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"5\"><label class=\"wpforms-field-label\">Camper Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1225-field_5\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][5][first]\" required><label for=\"wpforms-1225-field_5\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1225-field_5-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][5][last]\" required><label for=\"wpforms-1225-field_5-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1225-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_1\">Medication <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1225-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" required><div class=\"wpforms-field-description\">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&#8217;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. <\/div><\/div><div id=\"wpforms-1225-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_2\">Prescription # or Brand<\/label><input type=\"text\" id=\"wpforms-1225-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" ><\/div><div id=\"wpforms-1225-field_14-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Medication type <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1225-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_14_1\" name=\"wpforms[fields][14]\" value=\"Prescription\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_14_1\">Prescription<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_14_2\" name=\"wpforms[fields][14]\" value=\"Over the counter\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_14_2\">Over the counter<\/label><\/li><\/ul><\/div><div id=\"wpforms-1225-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"6\"><label class=\"wpforms-field-label\">Dosage <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1225-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_6_1\" name=\"wpforms[fields][6]\" value=\"1 teaspoon\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_6_1\">1 teaspoon<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_6_2\" name=\"wpforms[fields][6]\" value=\"2 teaspoon\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_6_2\">2 teaspoon<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_6_3\" name=\"wpforms[fields][6]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_6_3\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-1225-field_7-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Frequency <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1225-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_7_1\" name=\"wpforms[fields][7]\" value=\"Every hour\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_7_1\">Every hour<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_7_2\" name=\"wpforms[fields][7]\" value=\"Ever 2 hours\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_7_2\">Ever 2 hours<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_7_3\" name=\"wpforms[fields][7]\" value=\"Every 4 hours\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_7_3\">Every 4 hours<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_7_4\" name=\"wpforms[fields][7]\" value=\"Twice Daily\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_7_4\">Twice Daily<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1225-field_7_5\" name=\"wpforms[fields][7]\" value=\"As needed\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_7_5\">As needed<\/label><\/li><\/ul><\/div><div id=\"wpforms-1225-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_8\">First dosage to be administered at Camp <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1225-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><div class=\"wpforms-field-description\">Please include anticipated date and time<\/div><\/div><div id=\"wpforms-1225-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_9\">Prescribing Physician<\/label><input type=\"text\" id=\"wpforms-1225-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" ><\/div><div id=\"wpforms-1225-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_10\">Prescribing Physican telephone<\/label><input type=\"text\" id=\"wpforms-1225-field_10\" class=\"wpforms-field-small wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"(999) 999-9999\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-1225-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1225-field_12\">Special Instructions<\/label><textarea id=\"wpforms-1225-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" ><\/textarea><\/div><div id=\"wpforms-1225-field_13-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Parent\/Guardian Authorization <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1225-field_13\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][13][first]\" required><label for=\"wpforms-1225-field_13\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1225-field_13-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][13][last]\" required><label for=\"wpforms-1225-field_13-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">I hereby authorize Camp Deer Lake to administer listed medication to my child according to the instructions on the medication label.<\/div><\/div><div id=\"wpforms-1225-field_18-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"18\"><label class=\"wpforms-field-label\">Record of Dispensation<\/label><ul id=\"wpforms-1225-field_18\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_4\" name=\"wpforms[fields][18][]\" value=\"Monday Supper\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_4\">Monday Supper<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_5\" name=\"wpforms[fields][18][]\" value=\"Monday Bed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_5\">Monday Bed<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_12\" name=\"wpforms[fields][18][]\" value=\"Tuesday Breakfast\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_12\">Tuesday Breakfast<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_14\" name=\"wpforms[fields][18][]\" value=\"Tuesday Lunch\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_14\">Tuesday Lunch<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_16\" name=\"wpforms[fields][18][]\" value=\"Tuesday Supper\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_16\">Tuesday Supper<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_18\" name=\"wpforms[fields][18][]\" value=\"Tuesday Bed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_18\">Tuesday Bed<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_21\" name=\"wpforms[fields][18][]\" value=\"Wednesday Breakfast\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_21\">Wednesday Breakfast<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_22\" name=\"wpforms[fields][18][]\" value=\"Wednesday Lunch\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_22\">Wednesday Lunch<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_23\" name=\"wpforms[fields][18][]\" value=\"Wednesday Supper\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_23\">Wednesday Supper<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_24\" name=\"wpforms[fields][18][]\" value=\"Wednesday Bed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_24\">Wednesday Bed<\/label><\/li><li class=\"choice-25 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_25\" name=\"wpforms[fields][18][]\" value=\"Thursday Breakfast\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_25\">Thursday Breakfast<\/label><\/li><li class=\"choice-26 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_26\" name=\"wpforms[fields][18][]\" value=\"Thursday Lunch\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_26\">Thursday Lunch<\/label><\/li><li class=\"choice-27 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_27\" name=\"wpforms[fields][18][]\" value=\"Thursday Supper\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_27\">Thursday Supper<\/label><\/li><li class=\"choice-28 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_28\" name=\"wpforms[fields][18][]\" value=\"Thursday Bed\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_28\">Thursday Bed<\/label><\/li><li class=\"choice-29 depth-1\"><input type=\"checkbox\" id=\"wpforms-1225-field_18_29\" name=\"wpforms[fields][18][]\" value=\"Friday Breakfast\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1225-field_18_29\">Friday Breakfast<\/label><\/li><\/ul><div class=\"wpforms-field-description\">To be completed by person administering medication.<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1225\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/pages\/1230\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1225\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_crdt_document":"","jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-1230","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PbwKJP-jQ","_links":{"self":[{"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/pages\/1230","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/comments?post=1230"}],"version-history":[{"count":2,"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/pages\/1230\/revisions"}],"predecessor-version":[{"id":1502,"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/pages\/1230\/revisions\/1502"}],"wp:attachment":[{"href":"https:\/\/andrewsmemorial.org\/camp\/wp-json\/wp\/v2\/media?parent=1230"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}