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: ______________________________