SAMPLE Prescription_&_Non Prescription Medication Release.. (1).

SAMPLE PRESCRIPTION & NON-PRESCRIPTION MEDICATION RELEASE If any medical or emergency contact information changes following completion and submission of the Health and Prescription & Non-Prescription Medication Release forms, please be sure to provide... More

SAMPLE PRESCRIPTION & NON-PRESCRIPTION MEDICATION RELEASE If any medical or emergency contact information changes following completion and submission of the Health and Prescription & Non-Prescription Medication Release forms, please be sure to provide program/activity staff with any updated information. Participants must be able to self-administer all prescription and non-prescription medications. Program/activity staff members do not assist participants in taking their prescription or non- prescription medications, nor does program/activity staff remind participants to do so. This form must be signed by a parent/legal guardian. Participant Name (last, first):____________________,_____________________ Date of Birth: ______________ Program: [NAME AND DESCRIPTION] Prescription Medications Please indicate below whether your child will need to take prescription medications during the Program: ______ No, my child does not need to take any prescription medication while at the Program. [If yo Less