Wednesday, June 29, 2011

Marching Band Health Form (Side B)

Below is the Health Form (Side B) or download the form.
Please return this form at your uniform fitting or bring it to a Wednesday ngiht (optional) rehearsal. All forms need to be in my office no later than July 20, 2011.
Thank You for taking care of this detail.
Mr. B



Permission for Giving Prescription and Over the Counter Medications




I would like designated chaperones to administer my child’s prescription medication.

Medication(s) and time(s) to be given:






I give permission for designated chaperones to administer prescription medication to (student name)________________________________.

Parent Signature____________________________________________

Date______________________
______________________________________________________________________-________

Chaperones will carry a limited supply of over the counter medications during this trip. Permission needs to be given to administer these medications. (Please note that chaperones may not have what your child is taking at home.)


I give permission for designated chaperones to administer over the counter medication as necessary to my child (student name)___________________________________________

Parent Signature_________________________________________________

Date______________________



My child will be carrying and administering his/her own prescription and or over the counter medication.

Medication with student (please list):







I give permission for my child (student name) ________________________________________to self administer his/her own over the counter and or prescription medication.


Parent Signature____________________________________________
Date_________________________________________________


Please note any prescription medication must be in a container in which it was dispensed by prescribing physician and licensed pharmacist.