College Hill UMC Youth Request to Administer Medication

Please fill out this form, remembering to list all medications that may be needed for this youth event, and click submit. Note: you do not need to include permission to administer common over-the-counter meds in this form. That permission is included in the College Hill UMC youth consent and waiver form. Thank you!
NOTICE TO PARENTS & GUARDIANS: When any medication is to be taken in any youth activity, this form must be completed and signed. This included prescription and non-prescription medications. Prescription medicines must be in the original container from the pharmacy. Non-prescription medication must also come to camp in their original containers.
 
 
 
 
 
 
 
 
 

I request that the person named at the top of this form receive the above medications. I waive and release any action, cause of action or claim to liability for any loss, damages, accident or injury of any kind against College Hill United Methodist Church and against any staff or sponsors of College Hill United Methodist Church, arising from the administration of medication, including, but not limited, to any claim that medication was negligently administered and I agree to indemnify and hold harmless such persons and College Hill United Methodist Church from any claim. 

 
 
 
 

Description

Please fill out this form, remembering to list all medications that may be needed for this youth event, and click submit. Note: you do not need to include permission to administer common over-the-counter meds in this form. That permission is included in the College Hill UMC youth consent and waiver form. Thank you!