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Child Care Medication Authorization Form

Child care Medication Authorization Form Name of Child : : Today s Date: Name of Medication : Reason for Medication : Dose: Time/Frequency: Route: Date to Start: Date to stop: Expiration: Additional Instructions/Comments: Known side effects: I authorize ( Child care center) personnel to administer the Medication named above to my Child in the manner as stated. I release any liability in relation to the administration of this Medication . I also acknowledge that I, the parent/guardian, have given the first dose of this Medication without any allergic or unexpected reactions.

child care center) personnel to administer the medication named above to my child in the manner as stated. I release any liability in relation to the administration of this medication. I also acknowledge that I, the parent/guardian , have given the first dose of this medication without any allergic or unexpected reactions. Parent/guardian ...

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