Medications

MEDICATION

MEDICATION PERMISSION AND INSTRUCTIONS
If you are giving or applying any medication to a child in care, the following must be completed by the parent for each medication. An interruption in medication will require a new permission form.
TO BE COMPLETED BY PARENT OR GUARDIAN
I give my permission for Shine Day Camp...
...to give or apply this medication...*
...to my child...*
DIRECTIONS:
1. Date to Begin Giving Medication*
Date Format: MM slash DD slash YYYY
2. Date to Stop Medication*
Date Format: MM slash DD slash YYYY
3. Times Medication is to be Given*
4. Amount (dosage) of Medication Each Time Given*
5. Storage of Medication
6. Other Directions, if Any
Signature of Parent*
Date*
Date Format: MM slash DD slash YYYY
Digital Signature Acknowledgement*
- By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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MEDICATION PERMISSION AND INSTRUCTIONS