|
Treasured Times |
|
Authorization for Medication |
| For ___________________________________ |
| (Child's Name) |
| I, ________________________ give my permission to
Treasured Times Child Care to give _____________ to my child (ren).
Dose: __________ at the following times: _________ and ________.
Signed ___________________________________________ Date __________________ |
| I, ________________________ give my
permission to Treasured Times Child Care to give _____________ to my
child (ren). Dose: __________ at the following times:
_________ and ________.
Signed ___________________________________________ Date __________________ |
| I, ________________________ give my permission to
Treasured Times Child Care to give _____________ to my child (ren).
Dose: __________ at the following times: _________ and ________.
Signed ___________________________________________ Date __________________ |
| I, ________________________ give my permission to
Treasured Times Child Care to give _____________ to my child (ren).
Dose: __________ at the following times: _________ and ________.
Signed ___________________________________________ Date __________________ |
| I, ________________________ give my permission to
Treasured Times Child Care to give _____________ to my child (ren).
Dose: __________ at the following times: _________ and ________.
Signed ___________________________________________ Date __________________ |
| This form is used when a child needs to be administered medication. The parent is to fill out a form every day the child need the medication. |
 |
 |
|
|
