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.