KMAK Medical Authorization

KMAK Parental Authorization to Administer Medication

This medication form must accompany ALL medication to be given at KMAK.

All medications MUST be given to the Kamp First Aid person at the time of arrival. It is to be in the original container, whether it is a prescription or over the counter medication.

I hereby give my permission to the Kamp First Aid person and to designated Kamp staff to administer medication to my child at KMAK:

Name of child: ________________________________

Age:______ Weight:________

Name of medications: _____________________________________________________

______________________________________________________________________

Reasons for medication to be given and/or comments: ____________________________

______________________________________________________________________

______________________________________________________________________

Times to administer medication at kamp: ______________________________________

Dates to administer medication at kamp: ______________________________________

Side effects to be reported to parents: ________________________________________

Side effects requiring immediate medical attention: ______________________________

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