Imaginations Learning Academy

Non-Prescription Medication Release Form

Non-prescription medication and topical medications such as Tylenol, Dimetapp, sunscreen, Neosporin, etc. may be administered to a child only with written parental authorization. The following statement authorizes Imaginations Learning Academy to do so.

I (We), ______________________________, do hereby give permission for Melanie Munford of Imaginations Learning Academy (or any qualified staff member aid, or volunteer) to administer non-prescription medications (topical and oral) to my (our) child, _________________________. I (We) understand that I (We) shall be advised each time my (our) child receives such medicine.

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Mother/Guardian Signature & Date

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Father/Guardian Signature & Date