Full Text
PERMISSION TO ADMINISTER MEDICATION I hereby give my permission to : (NAME OF CHILD CARE PROVIDER) to administer medication to: (NAME OF CHILD) NAME OF MEDICINE: REASON FOR TAKING MEDICINE: AMOUNT/DOSAGE: MEDICINE TO BE GIVEN FROM: (DATE) (DATE) PARENT/GUARDIAN SIGNATURE: DATE: PERMISSION TO ADMINISTER MEDICATION I hereby give my permission to : (NAME OF CHILD CARE PROVIDER) to administer medication to: (NAME OF CHILD) NAME OF MEDICINE: REASON FOR TAKING MEDICINE: AMOUNT/DOSAGE: MEDICINE TO BE GIVEN FROM: (DATE) (DATE) PARENT/GUARDIAN SIGNATURE: DATE: